MIGRAINE: EPIDEMIOLOGY, GENETICS, AND COMORBIDITY

Background: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is caused by mutations in the NOTCH3 gene. Knowledge of disease expression in young adult NOTCH3 mutation carriers (MCs) is limited.
Objective: To characterize clinical, neuropsychological, and radiological status in NOTCH3 MCs younger than 35 years.
Design: Clinical characterization and blinded survey comparing MCs with non-MCs.
Setting: Referral center.
Participants: Individuals younger than 35 years who were at a 50% risk of a NOTCH3 mutation, from our CADASIL database. Thirteen individuals, from 8 families, met the criteria.
Methods: Comprehensive clinical, genetic, neuropsychological, and radiological investigations. Magnetic resonance images were scored according to a standardized white matter hyperintensities rating scale.
Results: Six individuals, from 5 families, were MCs. Clinical symptoms consisted of migraine (with aura), stroke, and stroke-like episodes. We did not find evidence for psychiatric disturbances, functional disability, or cognitive dysfunction, compared with non-MCs. Radiologically, a characteristic magnetic resonance imaging lesion pattern emerged for all MCs. This comprised white matter hyperintensities in the anterior temporal lobes, the frontal lobes, and the periventricular frontal caps.
Conclusions: Migraine (with aura) and stroke can present in NOTCH3 MCs younger than 35 years; however, more importantly, physical function and cognition are intact. Possible subtle cognitive dysfunction needs to be assessed in a larger study. White matter hyperintensities on magnetic resonance imaging are characteristic, and are consistently visualized from the age of 21 years and onward. Awareness of the clinical and radiological features of CADASIL in those younger than 35 years should increase early diagnosis and allow for customized counseling of young adults from families with CADASIL.     

MIGRAINE EPIDEMIOLOGY AND CLINICAL FEATURES

Objective: To investigate the cognitive functioning of migraineurs versus nonmigraineurs in a large population-based sample of middle-aged twins where headache diagnoses were established by neurologists.
Methods: Twins identified through the population-based Danish Twin Registry participated in face-to-face structured interviews, which included cognitive tests and two previously validated questions screening for migraine. Twins who screened positive for migraine and their cotwins were invited to participate in a telephone-based interview conducted by neurologists, who established headache diagnoses according to the International Headache Society criteria. Cognitive scores on fluency, digit span, delayed word recall, and symbol digit substitution test were compared between migraineurs and nonmigraineurs. Comparisons within monozygotic and dizygotic same sex twin pairs discordant for migraine were also performed.
Results: Of the 1789 twins who were eligible for inclusion in the present study, 1393 (77.8%) were interviewed. A diagnosis of migraine was established in 536 twins (migraine without aura n = 347; migraine with aura n = 157). Average scores on cognitive tests in twins with migraine or one of the migraine subtypes did not differ from those of nonmigraineurs in any of the tests. Comparisons within twin pairs discordant for migraine produced highly comparable results. Adjustment for possible confounders and stratification by cumulated number of lifetime attacks did not influence the results.
Conclusions: A lifetime diagnosis of migraine was not associated with cognitive deficits in middle-aged subjects.
And there is an accompanying editorial, excerpted below:     

偏头痛与心境障碍关系的Meta分析

目的:采用Meta分析对国内外已发表的有关偏头痛与心境障碍的相关文献进行综合分析,以探讨两者之间的相关性.方法:通过PubMed、The NEW ENGLAND JOURNAL of MEDICINE、中国期刊全文数据库(CJFD)和万方全文数据库进行检索,收集1988年1月～2011年12月发表的偏头痛与心境障碍关系的相关文献,应用Revman 5.0软件对所得资料进行Meta分析,选用固定效应模型进行合并效应量.结果:共纳入13项研究,偏头痛患者总数为9668例,其中偏头痛与抑郁共病的患者为2464例(25.5％);偏头痛患者抑郁的发生率较非偏头痛患者高,差异有统计学意义(OR=3.18,95％ CI=2.96-3.43,P＜0.00001).结论:偏头痛患者患抑郁的风险是非偏头痛患者的3.18倍,偏头痛合并心境障碍的机制尚有待于研究.     

儿童和青春期偏头痛临床特点

目的:通过与成年偏头痛患者临床特点比较,探讨儿童和青春期偏头痛的临床特点.方法:解放军总医院神经内科门诊2005年1月～2006年12月收集的45例儿童和青春期偏头痛及224例成年偏头痛患者,分析其一般资料及临床特点,包括头痛的发作频率、持续时间、程度、部位、性质和伴随症状.结果:(1)儿童和青春期以及成年偏头痛患者男女比例分别为1∶1.05和1:3.48(x2=13.493,P＜0.001);有先兆偏头痛占儿童和青春期以及成年偏头痛患者的比例分别为53.3%和21.9%(x2=18.754,P＜0.001).(2)儿童和青春期以及成年偏头痛患者的头痛发作频率分别为1(1～2)次/月和2(1～3)次/月(P=0.032),持续时间分别为6(2.5～24)h和24(7.25～36)h(P=0.001),头痛程度VAS分别为7.5(6～8)和8(7～9)(P=0.002).(3)儿童和青春期以及成年偏头痛患者单侧头痛所占各自比例分别为57.8%和65.2%(P=0.345),搏动性头痛占头痛性质比例分别为55.6%和67.9%(P=0.112).(4)儿童和青春期以及成年偏头痛患者出现伴随症状的比例分别为:恶心呕吐88.9%和92.0%(P=0.501),畏光怕声60.0%和70.5%(P=0.164),不愿活动86.7%和74.1%(P=0.071).结论:与成年偏头痛相比,儿童及青春期偏头痛患者的临床特点包括:男女比例接近,易出现先兆症状,持续时间更短、疼痛程度较轻、发作频率更少;二者的头痛部位、头痛性质以及伴随症状相近.     

阿米替林防治偏头痛的临床观察

目的:探索小剂量阿米替林对预防和治疗偏头痛的临床疗效、安全性和使用方法。方法:随机、单盲。阿米替林为试验组168例,西比灵为对照组126例,服药时间为3个月,疗效评价时间分别为服药后第3个月、第6个月及第9个月各一次,共3次。结果:阿米替林组的防治效果明显优于西比灵组（P<0.001）,不良反应较轻微。讨论:小剂量阿米替林防治偏头痛有肯定的疗效,而且副作用小、安全、价廉、无依赖性,并能改善睡眠,调整情绪。     

MIGRAINE, TYRAMINE AND BLOOD SEROTONIN

SYNOPSIS
Whole blood serotonin levels and headache symptoms were studied in 26 migrainous patients during a three day period with administration of tyramine the first day, reserpine the second day. No significant changes in serotonin occurred after tyramine; headache severity was not associated with change in blood serotonin, which dropped to low levels after a small dose of reserpine without precipitating migraine in most patients.     

慢性偏头痛和慢性紧张型头痛临床特征分析

目的:分析比较慢性偏头痛(CM)和慢性紧张型头痛(CTTH)的临床特征.方法:回顾性研究66例CM和CTTH的人口学特征及临床特征.结果:CM 46例,CTTH 20例.单因素分析显示CM组与CTTH组患者间的发病年龄,病程均有显著性差异(P＜0.05);CM组头痛程度多为中到重度,过度服用止痛药物的情况在CM组也更常见(P＜0.001);两组患者的性别和年龄没有差异.结论:CM患者的发病年龄早于CTTH患者,同时CM患者的头痛严重程度以及止痛药物过度使用情况均高于CTTH患者,CM患者应该与CTTH患者区别对待.在临床工作中,全面评估慢性头痛的临床特征,明确头痛的严重程度,正确诊断慢性头痛的类型,可以有效提高CDH患者的预后.