Chronic Migraine: A Prospective Descriptive Clinical Study in a Headache Center Population

This study describes the pain characteristics of the chronic migraine, including duration, intensity, quality, aggravation by activity, associated features in a headache clinic. One hundred twenty-one chronic migraine patients were evaluated. A total of 79% patients were female, and the mean age was 43.6 years, ranging from 19.0 to 54.2 years. The pain characteristics were predominantly unilateral; either side attacks (43.8%), strictly left-side (19%), or right side (19%). Headache character was reported as throbbing (67%), aching (14%), stabbing (10%), and pressure (9%). Of the associated autonomic features, lacrimation was the most common. Photophobia (83.5%) and phonophobia (72.7%) often were noted. When compared, only previous headache diagnosis, headache character and onset of headache were found to be statistically different between female and male patients ( P  < 0.05).     

Precipitating Factors in Migraine: A Retrospective Review of 494 Patients

SYNOPSIS
The predominance of certain triggers for migraine was assessed in 494 migraine patients. Stress (62%) was the most frequently cited precipitant. Weather changes (43%), missing a meal (40%), and bright sunlight (38%) were also prominent factors. Sexual activity (5%) was the precipitant cited by the least number of patients. Significant differences were found between men and women in their responses to weather changes, perfumes, cigarette smoke, missing a meal, and sexual activity.
Spring was cited by 14% of patients as a time for increased migraine attacks, followed by fall (13%), summer (11%), and winter (7%).     

Prevalence of Migraine and Headache in a High-Altitude Town of Peru: A Population-Based Study

A door-to-door population-based epidemiological study of the prevalence of migraine and headache in a sample of 3246 people older than 15 years of age was carried out in Cuzco, a high-altitude town in the Peruvian Andes, located at 3380 meters.
Among the 3246 screened people, there were 172 cases of migraine and 930 cases of headache, yielding a crude 1-year prevalence of 5.3% for migraine (2.3% among men and 7.8% among women) and 28.7% for headache (17.5% among men and 38.2% among women). Our results suggest that migraine prevalence in Cuzco is close to that of other developing countries, whereas headache prevalence may be higher than in other developing countries. Multivariate logistic regression suggested that both migraine and headache were related to the female sex, age, and anxiety and/or depression.
This study suggests that migraine is a relatively common disorder in Cuzco, but does not show any difference which could be significantly related to altitude. In contrast, our results suggest that headache may be more frequent at high altitude than at sea level.     

Flunarizine in Migraine: A Double-blind Placebo-controlled Study (in a Saudi Population)

We evaluated the effect of flunarizine (Fz) (10 mg/d) on migraine in a double-blind placebo-controlled design. The attacks' frequency, duration, severity and associated symptoms were compared before and after treatment. Forty-two patients completed a three-month trial period; 21 patients received Fz and 21 placebo. Statistical analysis showed no significant difference between Fz and placebo (p > 0.05). In this study Fz was not more efficient than placebo in migraine.     

Childhood Maltreatment and Migraine (Part I). Prevalence and Adult Revictimization: A Multicenter Headache Clinic Survey

(Headache 2010;50:20‐31) Objectives.— To examine the prevalence of childhood maltreatment and adult revictimization in migraineurs and the association with sociodemographic factors, depression and anxiety. Background.— Population and practice‐based studies have demonstrated an association of childhood abuse and headache in adults, although further details on headache diagnoses, characteristics, and comorbid conditions are lacking. There are mounting data suggesting substantial impact of early maltreatment on adult physical and mental health. Methods.— Electronic surveys were completed by patients seeking treatment in 11 headache centers across the United States and Canada. Physicians determined the primary headache diagnoses based on the International Classification of Headache Disorders‐2 criteria and average monthly headache frequency. Self‐reported information on demographics (including body mass index), social history, and physician‐diagnosed depression and anxiety was collected. The survey also included validated screening measures for current depression (Patient Health Questionnaire‐9) and anxiety (The Beck Anxiety Inventory). History and severity of childhood (<18 years) abuse (sexual, emotional, and physical) and neglect (emotional and physical) was gathered using the Childhood Trauma Questionnaire. There were also queries regarding adult physical and sexual abuse, including age of occurrence. Analysis includes all persons with migraine with aura, and migraine without aura. Results.— A total of 1348 migraineurs (88% women) were included (mean age 41 years). Diagnosis of migraine with aura was recorded in 40% and chronic headache (≥15 days/month) was reported by 34%. The prevalence of childhood maltreatment types was as follows: physical abuse 21%, sexual abuse 25%, emotional abuse 38%, physical neglect 22%, and emotional neglect 38%. Nine percent reported all 3 categories of childhood abuse (physical, sexual, and emotional) and 17% reported both physical and emotional neglect. Overlap between maltreatment types ranged between 40% and 81%. Of those reporting childhood abuse, 43% reported abuse in adulthood, but infrequently (17%) over the age of 30 years. In logistic regression models adjusted for sociodemographic variables, current depression was associated with physical (P = .003), sexual (P = .007), and emotional abuse (P < .001), and physical and emotional neglect (P = .001 for both). Current anxiety was also associated with all childhood abuse and neglect categories (P < .001 for all). A graded relationship was observed between the number of childhood maltreatment types and remote or current depression and anxiety. In adjusted logistic regression analysis, migraineurs reporting 3 or more categories of childhood trauma were more likely to have received diagnoses of both depression and anxiety (odds ratios [OR] = 6.91, 95% confidence interval [CI]: 3.97‐12.03), or either depression or anxiety (OR = 3.66, 95% CI: 2.28‐5.88) as compared with those without childhood abuse or neglect. Conclusion.— Reports of childhood maltreatment, especially emotional abuse and neglect, are prevalent in outpatients with migraine. There is extensive overlap of maltreatment types and a high rate of revictimization in adulthood. All types of childhood abuse and neglect are strongly associated with remote and current depression and anxiety, and the relationship strengthens with an increasing number of maltreatment types.     

The Journey to Establish CGRP as a Migraine Target: A Retrospective View

In this retrospective, Dr. Lars Edvinsson recounts early steps and milestones in our understanding of the neuropeptide calcitonin gene‐related peptide (CGRP) in the trigeminovascular system and its role in migraine. The discovery of the presence and function of CGRP and other neuropeptides in the cerebral vasculature and its sensory innervation is described. He relates the seminal finding that CGRP is uniquely released during migraine and the journey to develop blockers of CGRP effects. Now, over 30 years since its discovery, CGRP has become the target for a number of promising novel treatments for migraine patients.     

Long-Term Effects of Biofeedback on Migraine Headache: A Prospective Follow-Up Study

The aim of the present study was two-fold: to assess the long-term effects of biofeedback on migraine, and to determine the extent to which additional treatment after biofeedback treatment is completed can affect follow-up results. Ninety-six women whose migraine had been treated through biofeedback either 2-3 years (shorter follow-up) or 6-7 years (longer follow-up) earlier were divided into four groups according to how long ago they had received their biofeedback treatment and whether or not they had received any additional treatment (whatever the nature) since the posttreatment assessment: shorter follow-up without additional treatment (n = 24), shorter follow-up with additional treatment (n = 22), longer follow-up without additional treatment (n = 24), and longer follow-up with additional treatment (n = 26). Subjects were asked to keep a headache diary for five weeks, as they had done during earlier assessments. Overall, results showed that migraine activity was significantly less at follow-up than at pretreatment. However, whether the observed long-term benefits could be attributed to biofeedback was unclear because medication was found to be as much in use at follow-up as at pretreatment. Results also indicated that 51% of the subjects did seek additional treatment between posttreatment and follow-up. Contrary to expectations, however, additional treatment was not associated with better therapeutic benefits at follow-up. The research and the clinical implications of those findings are discussed.     

The Lack of Peripheral Pathology in Migraine Headache

This article reviews the baffling problem of the pathophysiology behind a peripheral genesis of migraine pain – or more particularly the baffling problem of its absence. I examine a number of pathophysiological states and the effector mechanisms for these states and find most of them very plausible and that they are all supported by abundant evidence. However, this evidence is mostly indirect; to date the occurrence of any of the presumed pathological states has not been convincingly demonstrated. Furthermore, there is little evidence of increased trigeminal sensory traffic into the central nervous system during a migraine attack. The article also examines a number of observations and experimental programs used to bolster a theory of peripheral pathology and suggests reasons why they may in fact not bolster it. I suggest that a pathology, if one exists, may be in the brain and even that it may not be a pathology at all. Migraine headache might just happen because of random noise in an exquisitely sensitive and complex network. The article suggests an experimental program to resolve these issues.