Trochleitis and migraine headache

Idiopathic trochleitis is a cause of superimposed ocular pain in patients with migraine. Trochleitis usually presents as an orbital pain without obvious ocular signs. Like greater occipital neuralgia, trochleitis may sustain or trigger the pain of chronic migraine. Diagnosis is confirmed by peritrochlear steroid injection, which produces a quick relief of periocular symptoms and may improve headache control.     

Comorbidities in cluster headache and migraine

The aim of this study was to investigate the most frequent comorbid diseases occurring in patients with cluster headache (CH) and, for comparison, in migraine patients. Over a period of eight years 130 patients with CH and 982 patients with migraine were diagnosed according to ICHD-II criteria. In all patients the presence and type of different diseases were assessed from medical records and coded by the ICD, X revision. Odds ratios (OR) with corresponding 95% confidence intervals (95% CI) were calculated by logistic regression analyses. Comorbid disorders were present in 56.9% patients with CH and in 56.7% migraine patients. Chronic sinusitis (p = 0.001), malignancy (p = 0.012), diabetes mellitus (p = 0.021), glaucoma (p = 0.038), as well as another primary headache disorders were more frequently present in patients with cluster headache (p = 0.001), than in migraine patients. In the multivariate analysis, chronic sinusitis (OR = 7.6, p = 0.001) and diabetes mellitus (OR = 4.2, p = 0.035), adjusted by gender, age and duration of headache, are more frequently associated with CH than with migraine. Comorbid disorders in CH patients were frequent and similar to those noticed in migraine patients, except chronic sinusitis and diabetes mellitus.     

Chinook winds and migraine headache

OBJECTIVE: To determine the effects of chinook weather conditions on probability of migraine headache onset. BACKGROUND: Many migraineurs believe weather to be a trigger factor for their headaches; however, there is little supportive evidence in the literature. Migraineurs in the southern part of the Canadian province of Alberta frequently report that chinooks, warm westerly winds specific to the region, trigger their headaches. METHOD: Weather data from Environment Canada were used to designate each calendar day during the study period as a chinook, prechinook, or nonchinook day. Headache data were collected from 75 patient diaries from the University of Calgary Headache Research Clinic. Individual and multiple logistic regression models were used to determine if the weather conditions affected the probability of migraine onset. Results: The probability of migraine onset was increased on both prechinook days (odds ratio 1.24; 95% CI 1.08 to 1.42) and on days with chinook winds (1.19; 1.02 to 1.39) compared with nonchinook days. Analysis of chinook wind velocities revealed that for chinook days, the relative risk of migraine onset was increased only on high-wind chinook days (velocity > 38 km/h) (odds ratio 1.41; 95% CI 1.06 to 1.88). A subset of individuals was sensitive to high-wind chinook days, and another subset was only sensitive to prechinook days. Only two patients were sensitive to both weather conditions, and the majority of patients was not sensitive to either. Neither weather condition had a protective effect. Increasing age was associated with high-wind chinook sensitivity (p = 0.009) but not prechinook sensitivity (p = 0.389). CONCLUSIONS: Both prechinook and high-wind chinook days increase the probability of migraine onset in a subset of migraineurs. Because few subjects were found to be sensitive to both weather types, the mechanisms for these weather effects may be independent. This is supported by the presence of an age interaction for high-wind chinook days but not for prechinooks day.     

Epidemiology of headache and migraine in women

During a survey of a defined community, 2,933 women aged 20 to 64 years were asked standard questions about headaches. Overall, 78·7% had headaches during the year immediately preceding the survey and this proportion decreased significantly with age. Random samples of subgroups with unilateral headaches, headaches preceded by a warning, and headaches accompanied by nausea were examined clinically. From these clinical diagnoses the prevalence of women with migraine during the previous year was estimated as 19%. Nearly half of those diagnosed as having migraine had never consulted a doctor because of headaches. Women with migraine and non-migrainous headaches kept diaries of all headaches and data are presented for the time and day of onset, severity, duration and relation of menstruation for both types of headache.     

Post-epileptic headache and migraine.

One hundred epileptic patients were questioned about their headaches. Post-ictal headaches occurred in 51 of these patients and most commonly lasted 6-72 hours. Major seizures were more often associated with post-epileptic headaches than minor attacks. Nine patients in this series of 100 also had migraine: in eight of these nine a typical, albeit a mild, migraine attack was provoked by fits. The post-ictal headache in the 40 epileptics who did not have migraine was accompanied by vomiting in 11 cases, photophobia in 14 cases and vomiting with photophobia in 4 cases. Furthermore, post-epileptic headache was accentuated by coughing, bending and sudden head movements and relieved by sleep. It is, therefore, clear that seizures provoke a syndrome similar to the headache phase of migraine in 50% of epileptics. It is proposed that post-epileptic headache arises intracranially and is related to the vasodilatation known to follow seizures. The relationship of post-epileptic headache to migraine is discussed in the light of current ideas on migraine pathogenesis, in particular the vasodilation which accompanies Leao's spreading cortical depression.     

Histamine metabolism in cluster headache and migraine

Summary Various parameters of histamine metabolism were studied in patients with migraine, cluster headache and chronic paroxysmal hemicrania. These included urinary excretion of radioactivity and of ¹⁴C histamine and its metabolites, exhaled ¹⁴CO₂ and fecal radioactivity after oral as well as subcutaneous administration of radioactive histamine.No marked deviation from the normal was found except in one patient with the cluster headache variant, chronic paroxysmal hemicrania, in whom an aberration in ¹⁴C histamine degradation seemed to be present. Only minute quantities of the ¹⁴C histamine metabolite C¹⁴ imidazoleacetic acid riboside seemed to be formed during a period with severe paroxysms. During a symptom-free period no deviation from normal was observed.The most likely explanation for this finding seems to be a defect in the conversion of imidazoleacetic acid to its riboside. This defect may possibly explain the increased urinary excretion of histamine in this particular patient. The relationship of this metabolic aberration to the production of headache still remains dubious for various reasons.

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Zusammenfassung Bei Patienten mit Migräne, Bing-Horton Kopfschmerz (cluster headache) und chronisch paroxysmaler Hemikranie wurden folgende Parameter des Histaminstoffswechsels untersucht:Die Urinausscheidung der Gesamtradioaktivität, C¹⁴-Histamin und seiner Abbauprodukte sowie die Menge von abgeatmetem C¹⁴-CO₂ und die Gesamtradioaktivität im Stuhl nach oraler und subcutaner Verabfolgung radioaktiv markiertem Histamins. Mit Ausnahme einer Patientin mit einer Variante des cluster headache — der chronisch paroxysmalen Hemikranie — wurden keinerlei Abweichungen von der Norm festgestellt. Bei der Patientin mit chronisch paroxysmaler Hemikranie schien eine Störung des Histaminabbaues vorzuliegen, indem zu Zeiten schwerer paroxysmaler Kopfschmerzen nur sehr geringe Mengen des C¹⁴-Histamin Abbauproduktes C¹⁴-Imidazolessigsäure-Ribosid gebildet wurden. Im symptomarmen Intervall wurden keine sicheren Abweichungen von der Norm festgestellt.Die naheliegendste Erklärung für diesen Befund scheint die Annahme eines Defektes in der Umwandlung von Imidazolessigsäure zu seinem Ribosid zu bieten. Dieser Defekt könnte möglicherweise die erhöhte Ausscheidung von Histamin im Urin dieser Patientin erklären.Die Bedeutung dieser Stoffwechselstörung für die Entstehung von Kopfschmerzen ist aus verschiedenen Gründen noch ungeklärt.

     

Endothelin 1 in migraine and tension-type headache

We determined the plasma levels of ET1, both interictally and ictally, in 50 migraine patients, 20 with aura (MPA) and 30 without aura (MPWA), comparing them with the levels of 40 age-matched tension-type headache patients (20 episodic and 20 chronic) (ETTHP and CTTHP) and the levels of a group of 20 healthy control subjects (CS). No statistically significant difference was evident between the mean ET1 plasma levels of MPA and those of MPWA, assessed in headache-free periods. The mean ET1 plasma levels of MPA and MPWA, assessed interictally, were significantly higher than those of CS. However, the values of plasma ET1 in ETTP and in CTTHP did not differ statistically from those of CS. MPA and MPWA ET1 plasma levels increased significantly within 2 h from the onset of attacks (p<0.0001) and remained significantly higher between 4 and 6 h from the onset. The ET1 plasma levels of ETTHP and CTTHP assessed during attacks did not differ statistically from those of the same patients assessed in the headache-free periods. The increase in ET1 levels in MPA and MPWA patients when assessed ictally, suggests that this peptide is involved in the haemodynamic changes and vascular tone modifications observed during migraine attacks, particularly in the first phase of the ictal period.     

Animal models of migraine headache and aura

PURPOSE OF REVIEW: Over the past 30 years, animal models of migraine have led to the identification of novel drug targets and drug treatments as well as helped to clarify a mechanism for abortive and prophylactic drugs. Animal models have also provided translational knowledge and a framework to think about the impact of hormones, genes, and environmental factors on migraine pathophysiology. Although most acknowledge that these animal models have significant shortcomings, promising new drugs are now being developed and brought to the clinic using these preclinical models. Hence, it is timely to provide a short overview examining the ways in which animal models inform us about underlying migraine mechanisms. RECENT FINDINGS: First generation migraine models mainly focused on events within pain-generating intracranial tissues, for example, the dura mater and large vessels, as well as their downstream consequences within brain. Upstream events such as cortical spreading depression have also been modeled recently and provide insight into mechanisms of migraine prophylaxis. Mouse mutants expressing human migraine mutations have been genetically engineered to provide an understanding of familial hemiplegic migraine and possibly, by extrapolation, may reflect on the pathophysiology of more common migraine subtypes. SUMMARY: Animal models of migraine reflect distinct facets of this clinically heterogeneous disorder and contribute to a better understanding of its pathophysiology and pharmacology.     

Limb pain in migraine and cluster headache.

Upper limb pain occurred in close temporal association with attacks of migraine, cluster headache and cluster-migraine in 22 cases. Seven had also lower limb pain. Limb pain was usually ipsilateral to the headache but could alternate sides and behaved like other accepted migraine accompaniments. It was always ipsilateral to the associated paraesthesiae/numbness (9 cases) and weakness (6 cases). The distribution and restricted localisations of limb pain were similar to those of the sensory symptoms and could not be accounted for by primary dysfunction of the peripheral or autonomic nervous systems. A central origin for limb pain is postulated. A temporary dysfunction in the somatosensory cortex, and/or its thalamic connections, during migraine or cluster headache attacks, might mediate such pain in a number of patients.     

Urinary histamine excretion in migraine and cluster headache

Summary Urinary excretion of histamine, as well as histaminuria following intravenous L-histidine loading, were studied in patients with so-called vascular headache.It was found that urinary excretion of histamine was increased on one or more occasions in 7 of 22 patients with cluster headache. The excretion was significantly higher on attack days than on attack free days. With migraine, increased excretion was found in 5 of 31 patients on days of an attack, whereas the corresponding figure for headache free days was 7 of 24 patients. Three patients showed increased histamine excretion during, as well as between, attacks. The excretion on attack days was not significantly different from that on attack free days. In cluster headache patients, L-histidine administration on attack days did not indicate that an increased histamine formation took place under such circumstances.The underlying mechanism behind the increased histamine output with cluster headache may be increased formation or liberation or altered catabolism. Histamine is more likely to be a consequence than the cause of an attack of cluster headache.

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Zusammenfassung Bei Patienten mit sogenanntem vaskulärem Kopfschmerz wurden die Histaminausscheidung sowie die Histaminurie nach intravenöser L-Histidinbelastung untersucht.Es wurden folgende Ergebnisse gefunden: Bei 7 von 22 Patienten mit Bing-Horton-Kopfschmerz (cluster headache) war die Histaminausscheidung bei einer oder mehreren Gelegenheiten erhöht. Die Ausscheidung war an Tagen mit Anfällen signifikant höher als an anfallsfreien Tagen.Bei 5 von 31 Patienten mit Migräne wurden an Tagen mit Anfällen eine erhöhte Ausscheidung gefunden. 7 von 24 Migränepatienten zeigten eine vermehrte Ausscheidung an anfallsfreien Tagen. Drei Patienten zeigten sowohl während als auch nach Kopfschmerzanfällen eine erhöhte Histaminurie. Die Ausscheidung an Tagen mit Anfällen war nicht signifikant verschieden von der an anfallsfreien Tagen.Bei Patienten mit cluster headache ergaben die Versuche mit L-Histidinbelastung an Tagen mit Anfällen keinerlei Hinweise für eine vermehrte Histaminbildung.Der zugrunde liegende Mechanismus der vermehrten Histaminausscheidung beim cluster headache kann entweder in einer vermehrten Bildung, einer verstärkten Freigabe oder einem veränderten Katabolismus bestehen. Das Auftreten von Histamin scheint eher eine Folge als die Ursache von Anfällen mit cluster headache zu sein.

     

Pupil diameter in migraine and tension headache.

Pupil diameter was measured in darkness and in dull and bright illumination in 39 migrainous patients and in 15 tension headache sufferers during headache. In 21 migrainous patients, measurements were repeated during the headache-free interval. Mean pupil diameter was smaller in patients with common migraine at the time of examination than in 20 nonheadache control subjects, and smaller on the symptomatic side in migrainous patients with unilateral headache. During the headache-free interval mean pupil diameter did not differ from values in non-headache controls. These findings suggest that migraine is associated with a sympathetic pupillary deficit which is greater on the habitually-affected side.     

A psychophysiological investigation of muscle-contraction and migraine headache

The function of the current study was to examine the psychophysiological responses and response stereotypy of three groups of subjects—migraine headache, muscle-contraction headache, low frequency headache controls—during rest, stress and post-stress adaptation periods. Each subject was interviewed and then exposed to several experimental conditions: a 15-minute rest condition, two stressors (cognitive and physical), and a post-stress adaptation period following each stressor. Dependent measures included frontal electromyogram (EMG), forearm EMG, earlobe blood volume pulse amplitude and heart rate. The results of this study were consistent with some previous research in finding no differences in EMG levels between muscle-contraction and control subjects, a significantly greater activation in cardiovascular measures for migraine subjects, and evidence for response stereotypy in the migraine headache group.     

Association of drinking water and migraine headache severity

ObjectivesMigraine is a common type of headaches and disabling disorder. Based on evidences dehydration is closely related to promote migraine headcahe frequency and severity. The Water intake is the best intervention to reduce or prevent headache pain. water intake in migraine patients has rarely been studied. the present study aimed to evaluate the relation between water intake and headache properties in migraine.Methods and materialsThe present study was conducted using a cross-sectional design on 256 women 18–45 years old referred to neurology clinics for the first time. The diagnosis of migraine by a neurologist the according to ICHD3 criteria and To assess migraine severity the Migraine disability assessment questionnaire (MIDAS), visual analog scale (VAS), and a 30-day headache diary were used.One-way analysis was used to evaluate the associations between MIDAS and VAS with daily water intake. Pearson correlation analysis was used to evaluate the relationship between the number of days and duration of headache with daily water intake.Data were analyzed using SPSS software and P-values < 0.05 considered statistically significant.ResultsThe results showed that the severity of migraine disability (P < 0.001), pain severity (P < 0.001), headaches frequency (P < 0.001), and duration of headaches (P < 0.001) were significantly lower in those who consumed more water or total water.ConclusionThe present study found a significant negative correlation between daily water intake and migraine headache characteristics but further clinical trials are needed to interpret the causal relationship.     

Autonomic dysfunction in pediatric patients with headache: migraine versus tension-type headache

Purpose

To examine symptoms indicating central nervous system (CNS) autonomic dysfunction in pediatric patients with migraine and tension-type headache.

Methods

A retrospective chart review assessed six symptoms (i.e. constipation, insomnia, dizziness, blurry vision, abnormal blood pressure, and cold and clammy palms and soles) indicating central nervous system (CNS) autonomic dysfunction in 231 patients, ages 5–18 years, diagnosed with migraine, tension-type headache (TTH), or Idiopathic Scoliosis (IS).

Results

Higher frequencies of “insomnia,” “dizziness,” and “cold and clammy palms and soles” were found for both migraine and TTH patients compared to the IS control group (P < 0.001). Frequencies of all six symptoms were greater in TTH than migraine patients with “cold and clammy palms and soles” reaching significance (P < 0.001).

Conclusions

The need for prospective research investigating autonomic dysfunction in pediatric headache patients is discussed.