Some lifestyle habits of female Belgrade university students with migraine and non-migraine primary headache

Abstract We performed a prevalence study to compare some lifestyle habits between subjects with migraine and those with nonmigraine primary headaches. We surveyed female students in randomly selected classes of the School of Medicine and the School of Pharmacy, Belgrade University. Among all observed students (1943 subjects), 245 had migraine and 1053 had non-migraine primary headache. According to multivariate logistic regression analysis, the following factors were associated with migraine: irregular eating (odds ratio (OR)=1.99; 95% confidence interval (95% CI), 1.69 to 2.34; p<0.01), sleep duration shorter than usual (OR=1.18; 95% CI 1.00 to 1.38; p=0.0449) and smoking >10 cigarettes per day (OR=1.18; 95% CI=1.00 to 1.39; p=0.0433). The results of the present study are in line with some other investigations suggesting that some lifestyle habits probably play a role as migraine precipitants.     

Cluster Headache with Aura

Aura was not recognized as a clinical symptom of cluster headache until fairly recently, but studies now have indicated that upwards of 20% of patients with cluster headache may have aura, the same percentage of migraine sufferers who have aura. This paper looks at the epidemiology of cluster headache with aura, suggests possible roles of cortical spreading depression in cluster headache pathogenesis, and looks at the clinical/diagnostic implications of aura in cluster headache sufferers.     

Medication-overuse headache in patients with cluster headache

Cluster headache (CH) is associated with the most severe pain of the primary headache disorders. Barriers to optimal care include misdiagnosis, diagnostic delay, undertreatment, and mismanagement. Medication-over-use headache (MOH) may further complicate CH and may present as increased CH frequency or development of a background headache, which may be featureless or have some migrainous quality. A personal or familial history of migraine appears to be strongly associated with the development of MOH in CH, at least with the phenotype of background headache. Patients with CH, especially those with a personal and/or family history of migraine, must be carefully monitored for MOH, and medication withdrawal should be considered if a CH patient presents with features of MOH.     

Current Aura Without Headache

Purpose of Review

This review evaluates and explains our current understanding of a rare subtype of migraine, typical aura without headache, also known as migraine aura without headache or acephalgic migraine.

Recent Findings

Typical aura without headache is a known entity within the spectrum of migraine. Its pathophysiology is suggested to be similar to classic migraines, with cortical spreading depression leading to aura formation but without an associated headache. No clinical trials have been performed to evaluate treatment options, but case reports suggest that most patients will respond to the traditional treatments for migraine with aura. Bilateral greater occipital nerve blocks may be helpful in aborting migraine with prolonged aura. Transcranial magnetic stimulation has shown efficacy in aborting attacks of migraine with aura but has not been specifically tested in isolated aura.

Summary

Typical aura without headache occurs exclusively in 4% patients with migraine, and may take place at some point in 38% of patients with migraine with aura. Typical aura without headache commonly presents with visual aura without headache, brainstem aura without headache, and can also develop later in life, known as late-onset migraine accompaniment.

     

典型偏头痛和普通型偏头痛TCD检查对照研究

对２０例典型偏头痛和４０例普通型偏头痛的ＴＣＤ进行对照研究，发现典型偏头痛发作期ＭＣＡ和ＰＣＡ在头痛侧平均血流速度明显加快，存在血管痉挛，普通型偏头痛发作期头痛侧与无症状侧平均血流速度无显著差异，提示典型与普通型偏头痛的发病机理可能存在本质区别，前者多数由血管因素所致。     

Coping with headache

OBJECTIVE: To describe self-initiated actions and cognitive strategies used for coping by women who suffer from episodic tension-type headache. DESIGN: Qualitative data from focus-group interviews were analysed according to Giorgi's phenomenological approach, inspired by Lazarus's theory of coping. SUBJECTS: A total of 15 women with tension-type headache, 20-60 years old, were recruited to three different focus groups through newspaper advertising. RESULTS: To cope with episodic tension-type headache, rhythm and balance in actions like eating, drinking, and sleeping were essential. Several women used thermal modulation. Exercise was important. Taking charge of their own time, pace, and level of commitment and accepting the fact that they had to live with their headache were cognitive strategies used. IMPLICATIONS: The general practitioner should identify the woman's choice of actions and cognitive strategies to manage her headache, and support her coping skills.     

Headache with Aura: A case report of ocular melanoma

Background

Headaches and visual complaints are common conditions encountered in the emergency department. While a patient's age, risk factors, and comorbidities often aid in risk stratification and guide emergency department evaluation, atypical presentations of serious disease may still occur in young otherwise healthy patients

Water-deprivation headache: a new headache with two variants

OBJECTIVES: To describe a new type of headache induced by water deprivation. BACKGROUND: Two medical students experienced headache over the previous 7 (C.A.K.) and 9 (J.M.S.) years when deprived of drinking water. In a tutorial on headache, they mentioned this precipitant, not recognized by the tutor (J.N.B.) or described in the medical literature. Dialysis and post-alcohol headaches are widely attributed to dehydration, but simple water deprivation has not been documented as a headache precipitant. METHODS: Family members, colleagues, and acquaintances were asked whether they experienced a headache when deprived of fluids. If they had, information was obtained regarding the location and quality of the headache, whether activity or posture influenced the pain, and what amount of fluid and time was needed to relieve symptoms. RESULTS: Approximately 1 in 10 interrogated subjects experienced water-deprivation headache, aching in the majority and accentuated by head movement, bending down, or walking. The 34 subjects were divided into 2 groups according to the time taken to relieve the headache by drinking water: total relief within 30 minutes by drinking 200 to 1500 mL (mean, 500) occurred in 22 subjects, and within 1 to 3 hours by drinking 500 to 1000 mL (mean, 750) in 11 subjects; 1 subject required sleep in addition to fluid intake. Surprisingly, the Internet revealed many references to water deprivation inducing headaches. CONCLUSIONS: Water-deprivation headache is common, recognized by the public, but not described in the medical literature. Here we delineate it as a primary headache, postulating that the pain arises from the meninges; that the brain is also involved is indicated by impaired concentration and irritability, although not studied in detail in this preliminary survey. We speculate that water deprivation may play a role in migraine, particularly in prolonging attacks. Further studies of serum osmolality could prove illuminating.     

Recognizing CADASIL: a Secondary Cause of Migraine with Aura

Purpose of Review

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is an important disease to consider in the differential diagnosis of migraine with aura. This review examines current literature regarding migraine in CADASIL, as well as diagnostic and treatment modalities.

Recent Findings

Recent studies have shown that smoking is a modifiable risk factor for progression of CADASIL (Chabriat et al. in Stroke 47:4–11, 2015). Specific imaging changes and findings on clinical exam can predict disease progression. However, migraine symptoms often precede MRI changes (Guey et al. in Cephalalgia 36:1038–47, 2015). A recent paper on migraine treatment in CADASIL reevaluates the prevailing belief that vasoconstrictive abortive medications are contraindicated in these patients (Tan and Markus in PLoS ONE 11:e0157613, 2016).

Summary

CADASIL is an autosomal dominantly inherited vasculopathy causing ischemic pathology in younger individuals due to a mutation in the NOTCH3 gene. The mutation results in impaired arterial contractility due to accumulation of granular osmiophilic extracellular material (GOM) in vascular smooth muscle cells (VSMCs). Clinical manifestations include migraine with and without aura, cognitive decline, ischemic events, and mood disorders. The presenting symptom is often migraine with aura. Characteristic MRI changes are often present. Genetic screening is available to confirm NOTCH3 mutation and pathognomic changes are often seen in skin biopsy. Treatment of migraine is similar to the general population, but with some notable and specific differences. Further studies in CADASIL, other small vessel arteriopathies, and migraine may help us understand more about the pathophysiology of these conditions and help with treatment development.

     

Characteristics of Migraine Visual Aura

Visual auras (VAs) of 100 patients with migraine with aura were studied by questionnaire. Visual auras accompanied the patients' first headache (HA) in 39% of patients. Only 19% had VAs with every attack. Patients with VAs over the entire HA history had a high frequency (greater than 50%) of attacks with VA; patients with VA during only part of the HA history had a low frequency (less than 50%} of attacks with VA. The auras occurred exclusively prior to the HA in 57%. The free interval between the end of the VA and the start of the HA was usually (75%) shorter than 30 minutes. Most (59%) patients had VAs that lasted from 1 to 30 minutes. They started in the periphery of the visual fields in 56%. The most common phenomena described were: small bright dots (42%), flashes of light (39%), "blind spots" (32%), and "foggy vision" (27%). Fortification spectra was reported by only 20%. Although most (65%) patients had a combination of phenomena, the majority (72%) had only one uniform constellation of manifestations. There was no clear-cut relationship between side of VA and side of HA.
Migraine VA is a pleomorphic and complex symptom. Many patients not qualifying for the diagnostic criteria of migraine with aura, as proposed by the International Headache Society (IHS) unequivocally present with visual phenomena that strongly suggest this diagnosis.