Personality traits and psychological reactions to mental stress of female migraine patients

The purpose of this study was (i) to compare a range of stress-related personality traits, including defense and coping mechanisms, of migraine patients (n = 23) with those of tension headache patients (n = 18) and dermatologically afflicted, but otherwise healthy, controls (n = 22), and (ii) to compare their state anxiety and other moods before, during, and after the presentation of a psychological stressor (mental arithmetic). For all three groups, mental arithmetic induced a significant increase in state anxiety and mood disturbance, followed by a subsequent decrease during recovery. Migraine patients were not found to have a higher disposition for anxiety, depression, or rigidity than tension headache patients or controls. Between the headache groups no differences in the use of defense and coping mechanisms were found. Compared to the control group, however, both migraine patients and tension headache patients were more inclined to use internally focused defense mechanisms and less inclined to seek social support when confronted with a problem. The psychological reaction of migraine patients to mental stress hardly differed from tension headache and control subjects. Compared to the control subjects, however, both groups of headache patients exhibited a diminished recovery from feelings of vigour, depression, and fatigue due to the stress induced. It is suggested that this distinct psychological reaction to stress of headache patients versus healthy control subjects is related to the more internally focused defense style of the headache sufferers. Thus, in contrast to previous results, this study does not present evidence of a migraine personality. It suggests the development of specific personality characteristics as a consequence of suffering from episodic headache.     

Migraine and the Noradrenergic Control of Vasomotricity: A Study With Alpha-2 Stimulant and Alpha-2 Blocker Drugs

SYNOPSIS
Involvement of the sympathetic nervous system in the pathogenesis of migraine attack has long been hypothesized, on the basis of anatomical, clinical and biochemical data.A double-blind placebo-controlled randomized study was carried out on 2 groups of 20 patients each: the first was affected by common migraine, the second by tension headache. Clonidine and mianserine effects were evaluated by testing the threshold of histamine-induced migraine, the intensity of induced pain and the migraine attacks' characteristics, after 90 days' preventive treatment. Hamilton Rating Scale for Depression was administered to evaluate anxiety and depression during the treatment. A long-term preventive effect on migraine incidence was registered using both drugs.     

Increased plasma matrix metalloproteinase-9 levels in migraineurs

BACKGROUND AND OBJECTIVE: Cortical spreading depression and neurogenic inflammation have been hypothesized to be key steps in the development of migraine headache. Recent studies have highlighted matrix metalloproteinase-9 (MMP-9) in cortical spreading depression, neurogenic inflammation, and cerebral ischemia. To seek their possible association, we investigated plasma MMP-9 levels in migraineurs during headache-free periods. METHODS: Plasma MMP-9 levels in 84 migraine subjects and 61 controls were determined by enzyme-linked immunosorbent assay. In addition, 23 patients with tension type headache were included in the study as comparative subjects. RESULTS: The MMP-9 levels in migraineurs (42.5+/-4.6 ng/mL, mean+/-SE) were significantly higher than those in controls (25.4+/-2.7 ng/mL, P< .005). Those levels in tension type headache subjects (24.6+/-4.8 ng/mL) did not differ from those in controls. There was no significant difference between subjects having migraine with aura and those without aura. The MMP-9 levels did not correlate with age, duration of illness, frequency of migraine attack, duration of headache attack, or medication for headache. Mean plasma MMP-9 levels were the highest in subjects from whom blood samples were taken 2-4 days after their latest attack. CONCLUSIONS: The degradation of extracellular matrix showing the increase of MMP-9 in migraineurs may be associated with an abnormality in their blood vessel permeability. MPP-9 plays some role in migraine pathophysiology. Further studies of MMPs are necessary to elucidate their role.     

Platelet serotonin measures in migraine

OBJECTIVE AND BACKGROUND: Serotonergic mechanisms play an important role in the pathogenesis of headache. To search for potential indicators of altered serotonin homeostasis in migraine, we have investigated three parameters of the platelet serotonin (5HT) system, platelet serotonin level (PSL), platelet serotonin uptake (PSU), and monoamine oxidase (MAO-B) activity, in a group of 55 patients with migraine and in 81 healthy controls. METHODS: After platelet separation, PSL was determined fluorimetrically; PSU was measured by incubating aliquots of platelet-rich plasma with six concentrations of 14C-5-HT for 60 seconds at 37 degrees C, followed by vacuum filtration; platelet MAO-B activity (toward kynuramine as a substrate) was determined fluorimetrically. RESULTS: Values of the investigated measures, in patients versus controls, amounted to (mean +/- SD) 608 +/- 166 vs. 591 +/- 184 ng/10(9) platelets for PSL, 139 +/- 25 vs. 142 +/- 25 pmol 5HT/10(8) platelets/minute for Vmax of PSU, 376 +/- 62 vs. 404 +/- 72 nM for Km of PSU, and 15.8 +/- 5.1 vs. 14.3 +/- 5.7 nmol product/10(8) platelets/60 minutes for velocity of MAO-B. Mentioned parameters did not show statistical differences between patients and controls, with exception of a small difference in Km of PSU, reaching significance (P<0.01). After subgrouping of patients according to diagnosis (migraine with aura, migraine without aura, and migraine attack) and gender, no differences retained significance. CONCLUSIONS: Our results indicate the absence of a measurable disturbance in 5HT homeostasis in migraine, as shown by platelet 5HT parameters, and they question the suitability of the use of mentioned blood elements in this regard.     

Cephalalgiaphobia: a possible specific phobia of illness

Psychiatric comorbidity, mainly anxiety and depression, are common in chronic migraine (CM). Phobias are reported by half of CM patients. Phobic avoidance associated with fear of headache or migraine attack has never been adequately described. We describe 12 migraine patients with particular phobic-avoidant behaviours related to their headache attacks, which we classified as a specific illness phobia, coined as cephalalgiaphobia. All patients were women, mean age 42, and all had a migraine diagnosis (11 CM, all overused acute medications). Patients had either a phobia of a headache attack during a pain-free state or a phobia of pain worsening during mild headache episodes. Patients overused acute medication as phobic avoidance. It is a significant problem, associated with distress and impairment, interfering with medical care. Cephalalgiaphobia is a possible specific phobia of illness, possibly linked to progression of migraine to CM and to acute medication overuse headache.     

BIOCHEMICAL COMPARISON OF MIGRAINE AND STROKE

SYNOPSIS
Gamma-aminobutyric acid (GABA) and 3', 5'-cyclic adenosine monophosphate (cyclic AMP) were measured in cerebrospinal fluid (CSF) of patients with stroke and vascular headache of migraine type. GABA was elevated in CSF of patients with recent onset of thromboembolic occlusive cerebrovascular disease (CVD) and within 48 hours of an attack of vertebrobasilar ischemia (VBI). Similarly, GABA was elevated in CSF of all patients studied during a migraine attack but not in asymptomatic migraine patients or patients with muscle contraction (tension) headache. CSF cyclic AMP was also elevated in patients with recent onset of thromboembolic occlusive CVD and in patients studied during or within 48 hours of a migraine attack.
Since biochemical abnormalities reported herein were common to occlusive CVD and migraine headache, it seems probable that they are due to ischemia associated with both conditions and possibly related to the resultant disorder of cerebral energy metabolism.     

The uptake, storage, and efflux of serotonin in platelets from migraine patients

A recently developed method for analysing 5-hydroxytryptamine (5-HT) efflux from platelets preloaded with a small amount of 14C-5-HT enables the assessment of the relative size of the granular and the cytoplasmatic pools of 5-HT within the platelets and of the rate of spontaneous efflux from these two compartments. This method, together with conventional assessment of the 5-HT uptake measures Km and Vmax, was applied in this study, comparing platelets from 14 patients with common migraine and 10 patients with classic migraine with platelets from 25 healthy controls. All patients were unmedicated and in an attack-free period. Neither the total patient group nor either of the two subgroups differed significantly from the control group on any measure of 5-HT uptake or efflux. However, two differences approached the conventional significance level: the relative size of the granular compartment (Compartment III) was larger for classic than for common migraine, and the efflux rate from Compartment III was shorter for classic migraine than for the healthy controls (P approximately 0.10 in both cases). Further studies are required to show whether these differences are real and, if so, whether they have any relevance for the pathogenesis of migraine attacks.     

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.     

Depression and anxiety in episodic and chronic cluster headache: a pilot study

Background.— In contrast to migraine and tension‐type headache, the psychiatric comorbidities of cluster headache (CH) have not been well‐studied. Objective.— We assessed the presence of depression and anxiety in groups of episodic CH (ECH) and chronic CH (CCH) patients and compared CH patients with and without depression and anxiety. Methods.— Sociodemographics, comorbidities, and selected headache features were ascertained from a clinic‐based sample in a cross‐sectional fashion from January 2007 to July 2010. Active depression and anxiety were assessed using the Patient Health Questionnaire (PHQ‐9) and the Generalized Anxiety Disorder 7‐item (GAD‐7) scales. Results.— Of 49 CH patients, ECH patients (n = 32) had an earlier age of onset and consumed less caffeine than CCH patients (n = 17). Rates of depression as defined by a PHQ‐9 score ≥10 were low in both ECH (6.3%) and in CCH (11.8%) with similar mean PHQ‐9 scores (3.1 vs 3.7, P = .69). Rates of anxiety as defined by a GAD‐7 score ≥10 were also low in both ECH (15.6%) and CCH (11.8%) with similar mean GAD‐7 scores (3.8 vs 3.4, P = .76). ECH patients in and out of active attack periods had similar levels of depression and anxiety. Depression and anxiety usually occurred together in ECH and CCH patients. CH patients who were depressed or anxious were more likely to present at a younger age and have attack‐related nausea and prodromal symptoms. Depressed CH patients were also more likely to have another pain disorder and had undertaken twice as many prophylactic medication trials. Conclusion.— In this clinic‐based cross‐sectional study, ECH and CCH patients had similarly low rates of depression and anxiety. Rates were lower than those reported for both episodic and chronic migraine.     

Prevalence and risk factors for depression and anxiety among outpatient migraineurs in mainland China

This study aimed to investigate the prevalence and risk factors for anxiety and depression symptoms in outpatient migraineurs in mainland China. In addition, we evaluated whether the Hospital Anxiety and Depression Scale (HADS) provided sufficient validity to screen depression and anxiety. A cross-sectional study was conducted consecutively at our headache clinic. Migraine was diagnosed according to International Classification of Headache Disorders, 2nd edition (ICHD-II). Demographic characteristics and clinical features were collected by headache questionnaire. Anxiety and depression symptoms about migraineurs were assessed using HADS. Several questionnaires were simultaneously used to evaluate patients with depressive disorder including the Hamilton Depression Rating Scale-17 (HAMD), Hamilton Anxiety Rating Scale (HAMA) and HADS. Pearson correlation analysis was applied to test the validity of HADS. 176 outpatients with migraine (81.8 % female) were included. Overall, 17.6 and 38.1 % participants had depression and anxiety, respectively. Possible risk factors for depression in migraineurs included headache intensity of first onset of migraine, migraine with presymptom, migraine with family history and migraine disability. The possible risk factors for anxiety included fixed attack time of headache in one day and poor sleeping, and age represented a protective factor for anxiety. The correlation coefficient of HADS-A and HADS-D with HAMA and HAMD was 0.666 and 0.508, respectively (P < 0.01). This study demonstrates that depression and anxiety comorbidity in our mainland Chinese migraineurs are also common, and several risk factors were identified that may provide predictive value. These findings can help clinicians to identify and treat anxiety and depression in order to improve migraine management.     

Muscle contraction headache.

This is the common "tension" or "nervous" headache. It is extracranial in origin, and is often precipitated by anxiety or depression. The headache is usually bilateral, nonpulsatile and of longer duration than migraine, with no focal signs or symptoms. While aspirin remains the most practical and useful analgesic for head pain of low intensity, combination agents are useful and drugs to control anxiety associated with headache are appropriate.     

Concentration and uptake of 5-hydroxytryptamine in platelets from cluster headache and migraine patients

Concentrations of 5-hydroxytryptamine (5-HT) in platelets were determined in 33 cluster headache patients (17 males) and in 34 migraine patients (16 males) outside attacks. The 5-HT uptake into platelets was measured and the kinetic constants V_max and K_m determined in 26 cluster patients (14 males) and in 30 migraine patients (13 males). Significantly lower 5-HT concentrations in whole blood were found in cluster headache and migraine patients than in 50 healthy controls (19 males). The V_max and K_m values of the 5-HT uptake were significantly lower in cluster headache and migraine patients compared with 22 healthy controls (9 males). The 5-HT concentrations and the kinetics of the 5-HT uptake did not differ between cluster headache and migraine. In healthy controls a significant positive correlation was found between the 5-HT uptake rate at 0.25 μM and K_m but not in cluster headache and migraine patients. The 5-HT concentrations in whole blood correlated positively with V_max and K_m, respectively, in cluster headache and with K_m in healthy controls but not with V_max nor with K_m in migraine. There was no obvious relation between the kinetics of platelet monoamine oxidase (MAO) and the 5-HT uptake except for an increased incidence of low V_max of MAO and low K_m of the 5-HT uptake in cluster headache. The kinetics of the 5-HT uptake was apparently not related to the state of migraine. The results indicate a possible constitutional trait in cluster headache and migraine expressed as low 5-HT concentrations in whole blood and low V_max and K_m of the 5-HT uptake into platelets.     

The importance of anxiety and depression as factors in chronicization of primary headaches

A multicenter study was carried out in 10 Italian headache centers to investigate the prevalence of anxiety and depression in patients with chronic daily headache(CDH). The study investigated 219 patients (171 F; 48 M) including 53 cases of chronic tension-type headache (CTTH), 99 cases of CTTH+ migraine and 67 cases of transformed migraine (TM). The type of headache diagnosed at the beginning was episodic tension-type headache (ETTH, n=32), ETTH + migraine (n=2), CDH ab initio (n=22), migraine with/without aura (n=151), not classifiable migraine (n=7) and not classifiable headache (n=3). The assessment of anxiety and depression was carried out using a Zung self-rating scale for anxiety (Zung A) and for depression (Zung D). The results show that anxiety and depression levels, in each group, were related to sex (F>M). Anxiety, but not depression, was related to the length of chronicization process. Anxiety and depression did not correlate with type of headache at onset, with ongoing headache or, surprisingly, with the abuse of anti-inflammatory drugs. These data suggest the chronicization is a biological and psychological trait.     

Platelet sulphotransferase activity, plasma sulphate levels and sulphation capacity in patients with migraine and tension headache

Activity of both the M- and P-forms of sulphotransferase (ST) was measured in platelets from patients with migraine, tension headache and controls. Mean PST values were 0.065±0.023 and 0.057±0.052 mnol/mg protein/min for migraine patients with and without aura. The corresponding values for tension headache and controls were 0.122±0.059 and 0.127:0.093 nmol/mg protein/min respectively (p<0.05). Mean MST values were not different for any of the groups, and MST and PST activities measured in two patients during a migraine attack were not significantly altered from baseline levels. Mean plasma inorganic sulphate concentrations and paracetamol metabolitcs were not significantly different in any of the groups studied. The results suggest that PST activity may be a factor in the aetiology of migraine.     

The impact of migraine on patients with major depressive disorder

BACKGROUND: The impact of migraine and other headache types among psychiatric outpatients with major depressive disorder (MDD) has not been fully described. OBJECTIVE: To investigate the impact of migraine on the severity, physical, and anxiety symptoms in patients with MDD and to examine the interaction between headache and depression. METHODS: This clinic-based study enrolled consecutive psychiatric outpatients meeting DSM-IV criteria for MDD. Headache types were diagnosed based on the International Classification of Headache Disorders, 2nd edition (2004). Three psychometric instruments were used to evaluate anxiety, depression, and physical components: the Hamilton Depression Rating Scale, the Beck Depression Inventory, and the Hospital Anxiety and Depression Scale. In addition, the interactions between headache and their depressive episode were also evaluated. RESULTS: Compared with patients without migraine, MDD patients with comorbid migraine (n = 73, 48.3%) had higher physical and anxiety scores on the three psychometric instruments. Migraine accounted for 5% to 11% of the variance of the total scores on the three psychometric scales. Approximately half (48.5%) of patients reported headache worsening during or after a depressive episode. CONCLUSIONS: Our study found that comorbidity of migraine in patients with MDD was associated with more anxiety and physical symptoms. Headache should not be considered as only a somatic symptom of depression, but should be treated as an important comorbid disorder because it might exacerbate or interact with depression during a depressive episode.     

Common Migraine: Criteria for Diagnosis

SYNOPSIS
Current definitions of common migraine are not specific and new criteria are needed. Our concept of common migraine was supported by comparing the features of 100 consecutive patients we diagnosed as common migraine, with past series. The features of our patients with common migraine were then compared with 100 cases of chronic daily headache, the only form of "tension headache" that can unequivocally be differentiated from migraine. The features that occurred significantly (P<0.001) more often in patients with common migraine than in those with chronic daily headache, were nausea, vomiting, unilateral site, throbbing quality, photophobia or phonophobia, increase with menstruation, and a family history of migraine. Criteria using these features, as well as other sets of criteria, were evaluated by retrospectively applying them to the patients diagnosed as having common migraine and chronic daily headache.     

Some clinical comparisons between common and classical migraine: a questionnaire-based study

In a questionnaire-based study we compared the clinical features of migraine with aura (classical migraine) and migraine without aura (common migraine) in 354 and 397 patients, respectively, attending The Princess Margaret Migraine Clinic. Other than those related to the aura, no significant differences were seen in any clinical features of the attack (e.g. frequency or duration of attacks, time of day at onset, location of headache at onset, severity of headache, or nausea and vomiting). Common migraine attacks were significantly more likely to occur at weekends (p = 0.002). Dietary triggers tended to be more troublesome in classical migraineurs while pregnancy and the menstrual cycle affected both migraine types equally. Classical migraine patients were twice as likely to have a history of hypertension (p less than 0.05) and showed a slightly but not significantly greater tendency to depression. Family histories of migraine were similar in each migraine type. We conclude that classical and common migraine are fundamentally similar in their clinical characteristics and that the occurrence of focal neurological symptoms during a migraine attack has little influence on the rest of the attack.     

The neuropsychology of migraine

Migraine is a common and recurrent headache disorder that may present with a variety of neurologic and non-neurologic manifestations. It has been classified into migraine with aura and migraine without aura. Research has shown that migraine affects verbal, visuo-spatial memory, and selective attention tasks. Cognitive impairments observed in migraineurs have been found to occur during a migraine attack, after the attack, and even when the individual does not exhibit any residual effects of the attack. Individuals with migraine are at a greater risk of developing anxiety and depression. Migraine disability is most commonly assessed using the Migraine Disability Assessment Scale (MIDAS), a simple five-item scale that assesses the individual's level of performance and areas of impairment. This review assesses the neuropsychological aspects of the complex malady that is migraine.     

Examination of anxiety, hostility and psychiatric disorders in patients with migraine and tension-type headache

The role of psychological factors related to headache has long been a focus of investigation. The aim of this study was to evaluate anxiety, depression, hostility and psychological symptoms in patients with migraine and tension-type headache (TTH) and to compare the results with healthy controls. Seventy-five subjects with migraine and 55 subjects with TTH (according to the criteria of the International Headache Society classification) and a control group including 73 healthy subjects were studied. The Buss-Durkee Hostility Inventory, Brief Symptom Inventory, State-trait Anxiety Inventory, Trait form were administered to the subjects. Compared with healthy controls, the patients with headache had significantly higher scores on measures of anxiety, depression and hostility and lower scores on psychological symptoms. The present results indicate the need to distinguish the unique dimensions of anxiety, depression and hostility that should be assessed in the population with headaches.     

Somatic symptoms in headache patients: the influence of headache diagnosis, frequency, and comorbidity

BACKGROUND: Mood disorders of anxiety and depression are well known to be comorbid with primary headache disorders. Less is known of the comorbidity of other somatic symptoms with headache. METHODS: Headache Clinic patients were screened with the Primary Care Evaluation of Mental Disorders (PRIME-MD), a multidimensional psychiatric screening tool. The prevalence of somatic symptoms was compared by headache diagnosis, frequency of severe headache, and psychiatric diagnosis. Follow-up data were obtained 6 months after consultation. RESULTS: Clinical diagnoses and PRIME-MD data were available for 289 patients. Associated somatic symptoms were more frequent in patients with chronic migraine (mean 5.5, P<.001) and chronic daily headache (CDH) (6.3, P=.008) compared to episodic migraine (4.0); in patients with severe headache >2 days per week compared to 2 days per week had significantly higher somatic counts (P=.01). Six-month follow-up data were available for 140 patients. Associated symptoms decreased both for patients with and without decrease in severe headache frequency (mean reduction of 1.0, P=.01 and 0.8, P=.003, respectively). CONCLUSION: Associated somatic symptoms are more common in patients with chronic migraine and CDH, with more frequent severe headaches, and with associated anxiety or depression. Patients with episodic migraine have similar somatic prevalence as a previously studied primary care population. The spectrum of headache disorders may be characterized as showing increasing somatic prevalence as headaches, particularly severe headaches, become more frequent.