Coexistence of cervicogenic headache and migraine without aura (?)

It is well known that migraine with aura may coexist with various unilateral headaches, like cluster headache and chronic paroxysmal hemicrania. It may also coexist with cervicogenic headache. The diagnosis of migraine without aura ("common migraine") poses greater problems than the diagnosis of migraine with aura. Cervicogenic headache diagnosis also poses problems when these two headaches coexist, since they have symptoms in common. Therefore, the scientific demonstration of coexistence of migraine without aura and cervicogenic headache is bound to be a difficult task. In the present study, migraine without aura and cervicogenic headache seemed to coexist in 4 patients (3 F and 1 M, mean age 50). Attacks with migraine characteristics fulfilled the IHS and IASP migraine criteria. Out of a maximum of 13 migraine characteristics based on the IHS/IASP migraine criteria, such as unilaterality, aggravation on minor physical activity, etc., none of the patients presented less than 11, as opposed to a mean of < or = 4 of these criteria in the cervicogenic type attacks. A similar system, based on criteria such as: reduction of range of motion in the neck, mechanical precipitation of attacks, etc., was also developed for cervicogenic headache. The mean number of cervicogenic headache criteria was 4.3 (out of a total of 5) in the "cervicogenic part of the picture", as opposed to 1.5 (1.8 if laterality is considered, see text) in the "migraine part of the picture". Drug regimens and anaesthetic blocks also showed different results in the two different headaches in the same patient. All in all, this study seems to support a coexistence of the two headache types.     

Molecular mechanisms of migraine?

Migraine is a common debilitating neurological disease characterised by attacks of severe headache with or without preceding aura. Its aetiology remains elusive; however it is clear that an interplay of genetic and environmental components play an important role. Familial hemiplegic migraine (FHM) is a rare and severe variant of migraine with aura and follows an autosomal dominant pattern of inheritance. This disease is genetically heterogeneous,with three causative genes having been identified. This review uses insights garnered from FHM to try and shed light on possible migraine disease pathogenesis.     

Random dominance and childhood migraine: a new marker? A controlled study of laterality in children with migraine

We assessed various aspects of laterality by direct observation in children with migraine and peer controls, with special reference to the frequency of random dominance. This frequency varied with the test battery used, being lower on the Edinburgh and Oldfield inventories which measure hand-use preference, and higher on the Handedness index and Spontaneous gestural index, which explore "genetic laterality". Random dominance would seem to be a new marker of migraine in childhood, for use alongside the hyperreactivity marker found in a previous study.     

Posttraumatic dystonia and hemiplegic migraine: different expressions of neuronal hyperexcitability?

The development of focal hand dystonia after a traumatic injury of the central or the peripheral nervous system is a rare condition with multifactorial predisposing factors. We report on a patient who developed focal dystonia of the left hand after a cervical whiplash injury. Magnetic resonance imaging did not show cerebral or spinal lesions, whereas a brain F-FDG PET scan revealed hypometabolism of the right primary sensory-motor cortex extending to the inferior and superior parietal lobule. The patient had a history of recurrent migraine attacks. Four months before the whiplash injury, she had transient dystonic posture of the left hand during a hemiplegic migraine attack. Brain magnetic resonance imaging scan and neurovascular investigations were negative. Among the predisposing factors to the development of trauma-induced dystonia, a putative role of neuronal hyperexcitability, shared by migraine and dystonia, is discussed.     

Dizziness and migraine: a causal relationship?

Both migraine and dizziness are very frequent complaints, but the comorbidity of the two disorders is higher than it might be expected to be on the basis of chance alone. This implies a possible causal relationship, but definite diagnostic criteria for migraine-related vertigo are still lacking. Very recent attempts in this direction have shown that migraine may be the third leading cause of vertigo and that migraine-related vertigo may be effectively treated. A review of the literature on this topic, which includes some preliminary data of our own, demonstrates the difficulty in pinpointing migraine-associated vertigo as a clearly-defined entity. However, there is a measure of agreement on a few points: the spells of vertigo occur in patients who habitually suffer from motion sickness, and who have a history of migraine, either without or with aura; the delay between migraine and vertigo onset may be several years; migraine-related vertigo may be described as rotatory and/or as a feeling of unsteadiness, and single spells can occur without any other accompanying symptoms, however, when spells do occur in association with headache, they usually precede it. The vertigo duration may be shorter or longer than that of the migraine aura since it ranges from a few seconds to a continuous condition of unsteadiness.     

Focal chronic ischemia and concomitant migraine: an atypical form of Sturge-Weber angiomatosis?

A young man with a left hemifacial hemangioma had during a six months period about forty left hemispheric neurologic attacks suggestive of classic migraine. The neurologic examination was normal during the attack-free period. The CT scan (fig. 1) and the M.R.I. study (fig. 2) only showed a moderate interhemispheric asymmetry. The left internal carotid angiogram showed subtle anomalies of the venous system (fig. 3). All the neurologic manifestations ceased as soon as therapy by aspirin was initiated. A Positron Emission Tomography (PET) study with the oxygen 15 continuous inhalation technique was performed 7 months after the last attack in order to measure the regional Cerebral Blood Flow (rCBF), Oxygen Extraction Fraction (rOEF) and Oxygen Consumption (rCMRO2). Striking, statistically significant, alterations were observed in the left temporo-parieto-occipital area (fig. 4) consisting of a "misery perfusion" syndrome (rCBF = 28-38 ml/100 g/mn; rOEF = 0.64-0.80), without alteration in the rCMRO2 (Table). A repeated PET study 12 months later was unchanged. The association of local chronic oligemia and ipsilateral facial hemangioma, ipsilateral cerebral hypotrophy and venous anomalies suggested the diagnosis of atypical leptomeningeal angiomatosis of the Sturge-Weber type. The importance and persistence of the hemodynamic alterations suggest that chronic oligemia and, hence, tissue hypoxia may participate in the pathogenesis of the migraine-like attacks. Moreover, local circulatory stasis with thrombotic events may be implicated, as suggested by the apparent efficacy of aspirin.     

Increased risk of migraine in Marfan's syndrome?

OBJECTIVE: To study the prevalence of migraine in Marfan's syndrome. MATERIAL AND METHODS: Patients were recruited from Landsforeningen (a patient organization) for Marfan's syndrome. A total of 46 persons were eligible for a validated semi-structured telephone interview by a physician trained in headache diagnostics. RESULTS: The prevalence of migraine without aura was 13% among men and 40% among women. The prevalence of migraine with aura was 44% among men and 37% among women. The overall prevalence of migraine was 63% with an equal sex ratio. This corresponds to a 3.6- and 2.0-fold significant increased risk among men and women, respectively, compared with the general population. CONCLUSION: The high prevalence and equal sex ratio of migraine is puzzling and likely to be secondary to Marfan's syndrome. It might be associated with dural ectasia, as the prevalence of dural ectasia is similar to that of migraine in Marfan's syndrome.     

Is migraine a genetic illness? The various forms of migraine share a common genetic cause

Is migraine a genetic illness? This question was previously controversial, but today the answer yes is generally accepted. The scientific evidence is the significantly increased familial risk of migraine, and the significantly higher concordance rate of migraine in monozygotic than dizygotic twin pairs. Finally, the three identified ion-channel genes that can cause familial hemiplegic migraine provide very strong evidence of genetics. Mutations in these genes can also cause sporadic hemiplegic migraine. The next question is whether the different types of migraine, i.e. migraine without aura, migraine with aura, sporadic hemiplegic migraine and familial hemiplegic migraine share a common genetic cause. This question is at present controversial. However, the fact that all types of migraine are paroxystic in nature suggest that a common genetic cause could be mutations in ion channels, although a common mutation has not yet been identified in the more common types of migraine: migraine without aura and migraine with aura.

     

Evaluation of serum transforming growth factor β1 and C-reactive protein levels in migraine patients

Background and purposeMigraine is a frequent form of headache. Although many mechanisms describing onset of migraine with and without visual aura have been suggested, the aetiology of migraine headaches is still not clear. Neurogenic inflammation may play a key role in the development of migraine headaches. We evaluated the discriminative power of serum levels of C-reactive protein (CRP) and transforming growth factor beta 1 (TGF-β1) in patients who presented to our clinic with migraine headaches with or without visual aura.Material and methodsWe designed a prospective case-control study of 51 patients with migraine (27 with migraine with aura and 24 with migraine without aura; all had headache) and compared them with 27 healthy subjects during the study period. Demographic and clinical characteristics recorded were age, sex, marital status, occupation, characteristics of headache, laboratory values, and serum CRP and TGF-β1 levels. Statistical analyses used Student t-test, the χ² test, and ANOVA followed by the post-hoc Bonferroni test for multiple comparisons. Receiver operator characteristic (ROC)-curve analysis for CRP and TGF-β1 was also conducted.ResultsThere was no difference between the groups in terms of demographic characteristics, marital status, and socioeconomic status. Statistically, white blood cell levels, serum glucose levels, triglyceride levels, high-density lipoprotein levels, and serum CRP and TGF-β1 were significantly higher in patients with migraine (p < 0.05). The ROC curve results in this study identified that CRP and TGF-β1 may discriminate patients who have different types of migraine headache.ConclusionsThis study suggests that serum CRP and TGF-β1 levels may be diagnostic factors to differentiate migraine patients with and without aura. These findings show that neurogenic inflammation may have a role in the aetiology of migraines.     

Is migraine a risk factor for the occurrence of eating disorders? Prevalence and biochemical evidences

The eating disorders (ED), anorexia nervosa (AN) and bulimia nervosa (BN), are severe psychiatric and somatic conditions occurring mainly in young woman. Although the aetiology is largely unknown, same evidences suggest that biological and psychological factors play a relevant role in the pathogenesis, along with monoamine, indole and same hypothalamic hormonal dysfunctions. Migraine is characterized by similar metabolic and psychological anomalies suggesting that a possible relationship exists between the two pathological conditions. To understand the possible relationship between migraine and ED, we have investigated the prevalence of migraine and the other primary headaches in a large group of AN and BN patients. In addition, we have studied the role of tyrosine metabolism in the same group of AN and BN young woman sufferers. In particular, we measured plasma levels of elusive amines: tyramine (Tyr) and octopamine (Oct) and catecholamines: noradrenalin (NE), dopamine (DA). The results of this study show that the prevalence of migraine in the woman affected by ED is very high (<75?%). The levels of Tyr and DA were higher and levels of NE were lower in the ED patients in respect to the control subjects. These biochemical findings suggest that abnormalities of limbic and hypothalamic circuitries play a role in the pathogenesis of ED. The very high prevalence of migraine in our group of ED sufferers and the biochemical profile of migraine, similar to that of ED patients shown in this study, suggest that migraine may constitute a risk factor for the occurrence of ED in young females. This hypothesis is supported by the onset of migraine attacks that initiated, in the majority of the patients, before the occurrence of ED symptoms.     

Ophthalmoplegic migraine: inflammatory neuropathy with secondary migraine?

BACKGROUND: This critical review provides a summary of the clinical presentation, neuroimaging, treatment and prognosis in pediatric ophthalmoplegic migraine (OM). The features of OM are not in keeping with its classification as a migraine-variant. METHOD: We review 3 new and 37 reported pediatric OM cases. RESULTS: Headache was an inconsistent feature, with 25% patients showing no evidence of pain at the initial OM episode. Patients demonstrated: 1) prolonged time for symptom resolution to occur (median time 3 weeks); 2) tendency for recurrent episodes to have more severe and persistent nerve involvement; 3) evidence of permanent neurological sequelae with recurrent episodes (30% of patients); 4) rapid improvement and shortened duration with corticosteroid therapy and; 5) transient, reversible MRI contrast enhancement of the affected cranial nerve (86% of patients). These features would not be expected in primary migraine headache. CONCLUSION: A detailed understanding of the natural history of OM is essential for the clinical. This review provides support that OM may result from cranial nerve inflammation with headache a secondary and later feature of this condition.     

Early treatment of migraine attacks with triptans: a strategy to enhance outcomes and patient satisfaction?

Treating migraine attacks early with triptans may be more effective than late triptan administration. However, in published studies, the definition of 'early' varied (in terms of time, pain intensity or presence of allodynia) or was unclear. Therefore, clear clinical indications have not been established. Appropriately designed trials to address this issue remain a priority. Early triptan treatment may also have disadvantages, including inadvertent treatment of tension-type headaches and danger of medication overuse. At present, only those migraineurs with rapid pain worsening, high pain recurrence rate and clinical indications of allodynia should be encouraged to take triptans as quickly as possible. This recommendation implies a requirement for patient education and the need to carefully tailor treatment to individual needs.     

Do others really know us better? Predicting migraine activity from self- and other-ratings of negative emotion

OBJECTIVE: The validity of self-reported negative emotion to predict health status is limited by response biases, introspection limitations, and methodological confounds. The reports of significant others about the patients' negative emotion may circumvent these limitations. This study sought to compare the validity of self- versus other-reported negative emotion as a correlate of migraine headache activity. METHODS: On 89 patients with migraine headache (74 women and 15 men), we correlated self-ratings and significant-other-ratings of patients' negative emotion with patients' report of migraine frequency and severity, which were assessed both cross-sectionally and prospectively, 3 months later. RESULTS: Other-reported negative emotion correlated with migraine activity better than did self-reported negative emotion, both cross-sectionally and prospectively. Patterns were different for women and men, however. Among women, other-reported negative emotion was positively associated with migraine activity. Among men, other-reported negative emotion was inversely associated with migraine frequency and severity. CONCLUSION: The results suggest that it may be valuable to obtain significant-other-ratings when assessing negative emotion in patients and that the genders may differ in how others' ratings are related to the patients' health.     

Menstrual migraine: what it is and does it matter?

Journal of Neurology - The diagnostic criteria of menstrual migraine (MM), migraine related to menstruation and pure menstrual migraine, are placed in the appendix of the International...