Cardiovascular Reflexes and Plasma Noradrenaline Levels in Migraine Patients Before and During Nimodipine Medication

SYNOPSIS
In twenty-one migraine patients, cardiovascular reflex responses and noradrenaline (NA) levels were measured before and after four weeks of calcium antagonist nimodipine medication. Nineteen healthy subjects served as a control group for cardiovascular reflex responses and ten of them as a control group for noradrenaline levels.
Neither the cardiovascular reflexes nor the noradrenaline levels differed significantly when the values before and after four weeks of nimodipine medication were compared with each other.
The mean pulse rate reaction connected with both normal and deep breathing differed significantly when the results of migraine patients and controls were compared with each other, this result suggesting subtle parasympathetic hypofunction in migraine patients. When the mean Valsalva ratios and the mean postural pulse rate reaction ratios were compared, the ratios in migraine patients were significantly lower than in control subjects (p<0.025), suggesting sympathetic hypofunction in migraine patients. The mean diastolic blood pressure rise in migraineurs in the isometric work test was 15.2 ± 9.4 and in controls 24.0 ± 9.4 (p<0.001). The baseline levels of the NA determinations did not differ when the values of migraineurs and controls were compared with each other; but after 3 minutes of standing, the rise in NA levels in migraine patients was significantly lower than in controls (p<0.05). These results suggest sympathetic hypofunction in migraineurs.     

Impaired Cardiovascular Reflexes in Cluster Headache and Migraine Patients: Evidence for an Autonomic Dysfunction

SYNOPSIS
To investigate autonomic nervous system involvement in cluster headache (CH) and migraine, we compared the cardiovascular reflex responses of common migraine and CH subjects to a group of controls. A battery of 5 well-codified autonomic tests was applied: (1) deep breathing test (DB); (2) lying to standing test (LS); (3) Valsalva manoeuvre (VAL); (4) postural hypotension test (PH); (5) blood pressure response to sustained handgrip (SHG). Our data confirm an autonomic dysfunction in CH, mainly affecting the parasympathetic system. Evidence for an impairment of sympathetic cardiovascular reflex regulation was obtained in the common migraine group.     

Migraine,Migraine Features,and Cardiovascular Disease

(Headache 2010;50:1031‐1040) Background.— Many studies support an association between migraine and cardiovascular disease (CVD). This association appears particularly in migraine with aura and is also modified by additional factors. Objective.— We sought to investigate whether the association between migraine and CVD in addition to aura status is affected by certain migraine features. Methods.— Cohort study among 27,840 women, participating in the Women's Health Study. We had detailed self‐reported information on migraine and migraine features among women with active migraine (migraine during the year prior to baseline). Incident CVD events were confirmed after medical record review. We used Cox proportional hazards models to evaluate the association between migraine and incident CVD. The results have been presented in part before. We ran additional analyses according to migraine features. Results.— At baseline, 5125 (18.4%) women reported history of migraine; 39.7% of the 3610 women with active migraine indicated aura. During a mean of 11.9 years of follow‐up, 708 CVD events occurred. Migraine with aura doubled the risk for CVD, ischemic stroke, and myocardial infarction. With regard to ischemic stroke, this association seemed stronger in the absence than in the presence of migraine features. This was most pronounced in the absence (hazard ratio = 3.27; 95% CI = 1.93‐5.51; P < .0001) than in the presence of nausea/vomiting (hazard ratio = 0.91; 95% CI = 0.43‐1.93; P = .80). In contrast, the association with myocardial infarction did not reveal a certain pattern. Conclusions.— These data suggest that the association between migraine with aura and ischemic stroke may differ by absence or presence of migraine features.     

Cardiovascular Reflex Responses During Migraine Attack

SYNOPSIS
The cardiovascular reflex responses of 10 migraine patients were recorded during both migraine attacks andheadache-free intervals. Ten healthy subjects of similar age and sex served as a control group.When the results of the measurements for migraine patients performing an isometric work test duringmigraine attacks and during headache-free intervals were compared, during migraine attacks a statisticallysignificant smaller increase in diastolic B.P. was encountered than interictally (p<0.05).When the results for migraine patients during migraine attack, and controls, were compared, statisticallysignificant differences were encountered in the pulse rate variation in Valsalva manoeuvre, in an orthostatictest, and in the systolic and diastolic blood pressure reactions in an isometric work test. The mean Valsalvaratio and R-R-interval ratio during the orthostatic test were lower in migraine patients during migraine attackthan in controls, and the mean blood pressure rise in the isometric work test was also lower in the migrainepatients group during attacks.There were no statistically significant differences between the results of the migraine patients duringheadache-free intervals and those of the control subjects.     

Cardiovascular Risk in Young Finns

This report describes the general outline and progress of a multicentre study on risk factors of coronary heart disease and their determinants in children and adolescents. “Cardiovascular Risk in Young Finns” comprises a cross-sectional study of 3 to 18-year old subjects in 1980, and follow-up studies in 1983 and 1986 in various parts of Finland, and in 1989 in one of the study areas (Turku). The number of participants in 1980 was 3596 (83.1%) of those invited. In 1983 and 1986 83.2% and 77.8% of them, respectively, participated. The study programme has comprised questionnaire data on, for example, general health and living conditions, physical activity, eating habits, smoking, and psychological variables. The physical examination covered height, weight, skinfold thickness, pubertal stages and blood pressure. Blood specimens were obtained to assess concentrations of serum lipids and insulin, and in 1986 also for possible genetic markers of hypercholesterolemia. A 48 hour recall on nutrient intake was obtained from some of the subjects. The follow-up studies have enabled a study of the tracking phenomenon. Other important questions under study include, for example, the possible clustering of risk factors and their determinants. The cohorts studied provide a valuable research basis for the future, with emphasis on enabling a long-term follow-up of the subjects.     

Migraine Headache in the Infant and Young Child

Migraine is a common clinical diagnosis, occurring in 4-10% of school age children. Migraine in the infant and preschool child has been infrequently described in retrospective studies. We report the prospective evaluation and therapy of six children (5-42 months) with migraine. In four of the children, Prensky's criteria were used for diagnosis, while the two youngest children presented with ophthalmoplegic migraine. All children had a strong family history of migraine and presented with headache and prominent features including facial pallor, irritability, sleep disturbance or mood changes. The oldest four children were successfully treated with either amitriptyline or imipramine in low doses. The infants with ophthalmoplegic migraine failed to completely respond to any therapy. At followup 2 to 18 months later, all children were well and without toxicity. The pediatrician should be aware that migraine may begin in infancy and can be effectively and safely treated.     

Cardiovascular Sympathetic Hypofunction in Muscle Contraction Headache and Migraine

There have been some recent reports proposing that muscle contraction headache (MCH) and migraine are similar and may have a common etiology. It has been hypothesized that derangement of the autonomic nervous system (ANS) plays an important role in the pathogenesis of migraine. However, reports on the ANS function in MCH have rarely been submitted. Therefore, in this report, MCH patients were investigated as well as migraine patients. The cardiovascular reflex responses by orthostatic test, isometric work test and the pulse rate (R-R interval) variation in fifteen MCH patients and fifteen migraine patients were recorded during headache-free intervals. The plasma norepinephrine (NE) levels were also measured throughout the orthostatic tests. Fifteen healthy subjects served as the age-matched control group. In the MCH group and the migraine group, blood pressure immediately after going from the supine to the erect position decreased more significantly than in the control group. The basal NE level was significantly low in both the MCH group and the migraine group, in comparison with the control group. MCH patients as well as migraine patients showed cardiovascular sympathetic hypofunction.     

Effectiveness of Nonpharmacologic Treatment for Migraine in Young Children

(Headache 2010;50:219‐223) Objective.— To evaluate the effectiveness of nonpharmacologic treatment for migraine in children younger than age 6 years. Background.— The mean age of onset of migraine in children is 7.2 years for boys and 10.9 years for girls. Treatment consists of individually tailored pharmacologic and nonpharmacologic interventions. However, data on migraine management in preschoolers are very sparse. Methods.— Demographic, clinical, and outcome data were collected from the files of patients with migraine who attended a pediatric headache clinic. Only those treated by nonpharmacologic measures, namely, good sleep hygiene, diet free of food additives, and limited sun exposure, were included. Clinical factors and response to treatment were compared between children younger than 6 years and older children. Results.— Of the 92 children identified, 32 were younger than 6 years and 60 were older. There was no difference between the age groups in most of the demographic and clinical parameters. The younger group was characterized by a significantly lower frequency of migraine attacks and shorter disease duration (in months). Mean age of the patients with no response to treatment (grade 1) was 10.588 ± 3.254 years; partial response (grade 2), 9.11 ± 4.6 years; and complete response (grade 3), 8.11 ± 3.93 years (P = .02). The percentage of patients with complete to partial response as opposed to no response was significantly higher in the younger group (P = .00075). Conclusion.— As the primary option, conservative therapy for migraine appears to be more effective in children younger than 6 years than in older children, perhaps because of their shorter duration of disease until treatment and lower frequency of attacks.     

Platelet Antibodies in Patients With Migraine

The reported decrease of platelet serotonin receptors in patients with migraine could be due to an autoimmune reaction. We, therefore, examined sera from 42 migraineurs without aura, 26 migraineurs with aura, and 107 headache-free blood donors for platelet-reactive antibodies using the platelet adhesion immunofluorescence test, the NIH-lymphocytotoxicity test, and the monoclonal antibody-specific immobilization of platelet antigens test. IgG antibodies against non-HLA class I platelet antigens were found in 9.5% of patients with migraine without aura, 7.6% of patients with migraine with aura, and in 7.5% of controls; IgM antibodies were found in 11.9% of patients with migraine without aura, in 30.8% of patients with migraine with aura, and in 13.1% of controls. Most antibodies ware directed against glycoprotein complexes IIb-IIIa (fibrinogen receptor) or IB-IX (thrombin receptor). Two patients with migraine without aura but no patient with migraine with aura nor any control subject had IgG antibodies of unknown specificity. One patient (2.4%) with migraine without aura and two patients (7.7%) with migraine with aura, as well as 2 controls (1.9%) had IgM antibodies not further specified. The differences in frequency of platelet antibodies of known or unknown specificity in patients with migraine without aura and migraine with aura and controls were not statistically significant. Therefore, our data do not support the hypothesis of a pathophysiologically relevant autoimmune reaction against platelet serotonin receptors in the majority of patients with migraine. We can not exclude the occurrence of antibodies against neuron-specific serotonin receptors.     

Sleep in Patients with Chronic Migraine

Purpose of Review

The biological and pathophysiological interaction between sleep and chronic migraine (CM) remains to be fully elucidated. In this article, we provide a narrative review of the literature on sleep disturbance and CM, highlighting recent advances in sleep research and insights into mechanisms that could mediate a role of sleep disturbances in migraine chronification. We discuss the potential for cognitive-behavioral insomnia therapy (CBTi) as an intervention for CM with comorbid insomnia. Finally, we propose a model of the mechanisms underlying the interactions among sleep physiology, maladaptive migraine-coping behaviors, and coexisting factors which contribute to sleep disturbances in CM based on conceptual models used in sleep research.

Recent Findings

Insomnia is the most common sleep complaint among patients with CM. CM patients experience more frequent and severe insomnia symptoms than patients with episodic migraine (EM). It has been suggested that sleep disturbances may predispose individuals to migraine attacks, which may affect the pain-processing trigeminovascular system and thus play a role in migraine progression. Encouraging but limited evidence suggests that management of insomnia via behavioral sleep therapy may reverse CM to EM and possibly prevent migraine chronification.

Summary

Migraine has a complex relationship with sleep. The use of objective sleep study such as polysomnographic microstructural sleep analysis and actigraphy could help connect sleep disturbances and processes related to CM. Future longitudinal studies should examine whether effective behavioral treatments such as CBTi can reverse migraine chronification.

     

Disturbed Liver Function in Migraine Patients

SYNOPSIS
Hepatic function as estimated from the plasma kinetics of antipyrine has been determined in 32 migraine patients. A high proportion of patients exhibited abnormal plasma half-life and metabolic clearance rates for this drug. The serum levels of copper and zinc were also estimated in these patients; the ratio copper:zinc was uniformly higher than that of controls.     

Platelet Fibrinogen Receptors in Migraine Patients

SYNOPSIS
In order to determine the platelet characteristics responsible for aggregation, the number and apparent dissociation constant (K D aPP ) of fibrinogen receptors were determined in 12 women with common migraine. The studies were performed by the use of 125 -fibrinogen. The patients were assessed in headache-fee intervals. The mean number of platelet fibrinogen receptors exposed in migraine patients was significantly higher than those obtained in healthy controls (p<0.05). The (K D aPP ) in migraineurs was about three times lower than in the controls (p<0.02). The results indicate that both the number and affinity of fibrinogen receptors or platelets are increased in migraine patients. The authors conclude that this phenomenon may be responsible for the increased number of circulating platelet aggregates in migraine patients and for the prevalence of various kinds of strokes during migraine attacks.     

Serotonergic, Catecholaminergic, and Cardiovascular Reactions to Mental Stress in Female Migraine Patients. A Controlled Study

This study aimed at the combined assessment of the serotonergic and sympathetic nervous system reactions of migraine patients before, during, and after the induction of mental stress in order to detect the possible role of these reactions in inducing a migraine attack. The responses to mental stress of the migraine patients were compared to a group of patients suffering from tension headache and a control group. Activation of the sympathoadrenomedullary system due to mental stress was successfully induced in the migraine patients (n=23), in the tension headache patients (n=18), and in the control group (n=22). The results of this study present evidence of increased cardiovascular activity in migraine patients as compared to nonmigraineurs. However, no evidence was found of a specific serotonergic, sympathoadrenomedullary, or cerebrovascular response of migraine patients to mental stress as compared to nonmigraineurs.     

The Evaluation of Atherosclerosis in Migraine Patients

Abstract A potential association might exist between atherosclerosis and migraine. Carotid intima‐media thickness (CIMT) is a marker of generalized atherosclerosis; hence, we aimed to assess CIMT in migraine patients. This study included 30 patients and 60 healthy controls aged between 20 and 40 years. Episodic migraine diagnosis was made according to the criteria of International Headache Society (IHS). Healthy controls who do not suffer any headache problems were selected from among hospital and laboratory staffs. All subjects were evaluated regarding some parameters and features known to be associated with migraine and vascular changes, that is, gender, age, body mass index, blood pressure, cholesterol, smoking habits, used hormonal contraceptives, and history of disease. The left common carotid arteries of the subjects were examined, and CIMT was measured with real‐time gray‐scale sonography. Mean values and standard deviations were calculated. All measurements were made in migraine‐free periods. Migraine patients and control subjects were well matched for those parameters known to be associated with vascular changes, that is, gender, age, BMI, blood pressure, and cholesterol. CIMT values were higher in patients. The results showed that the mean CCA IMT values were 0.493 ± 0.074 mm and 0.409 ± 0.053 mm in migraine patients and controls, respectively (P < 0.001). There is a relationship between atherosclerosis and inflammation in migraine patients. The risk of cranial inflammatory arteriopathy increases in repeated attacks of migraine. Our study also supports that high number of attacks and attack duration are important in the development of atherosclerosis.     

偏头痛患者的微循环及血液流变性分析

目的 探讨偏头痛与微循环、血液流变性的关系。方法 选择80例偏头痛患者组及80例健康对照组,从甲襞微循环加权积分值、球结膜微血管的异常率及血液流变性三方面进行比较分析。结果 偏头痛患者组存在明显的微循环障碍和血液流变性异常,其改变程度与病情、病程呈正相关。甲襞循环的各项积分值和球结膜微血管异常率均高于对照组(P<0.01)。其全血粘度、血浆粘度、红细胞压积及血小板粘附率与对照组相比,有显著性差异(P<0.01)。结论 通过微循环观察和血液流变性检测,对估计偏头痛患者的病情、指导治疗及判定疗效,具有重要的临床意义。     

Cerebral Infarction in Patients With Migraine Accompaniments

SYNOPSIS
Migraine accompaniments (MA) are transient visual, sensory, motor or behavioral symptoms that are identical to the auras of classical migraine and are thought to have a similar underlying mechanism but which do not occur in association with headache. Cerebral infarction may rarely occur during an episode of migraine and if no other more obvious etiology can be found the infarct is thought to be related to migraine. Cerebral infarction, to our knowledge, has not been reported in association with MA. We now report four patients with a history of MA who developed cerebral infarction. Infarctions were occipital in two cases, frontoparietal in one case and parietal and cerebellar in one case. All patients showed good recovery. The mechanism for cerebral infarction in MA is probably similar to that of infarcts seen with classical migraine.     

Autonomic Function Testing in Patients with Migraine

SYNOPSIS
Autonomic nervous system function was studied in 62 patients with migraine. The Valsalva maneuver, deep breathing test, sustained handgrip test, orthostatic test and spectral analysis of heart rate variability in the supine and standing positions were performed in a group of 62 patients of both sexes, aged 21 to 50 years, and in an age-matched control group of 45 healthy volunteers.
Heart rate increase during sustained handgrip was significantly reduced in the headache group, when compared to the control group, while the results of the remaining cardiovascular tests did not significantly differ between the control and headache groups. In standing patients, the integrals of middle frequency bands of amplitude spectra were smaller in patients than in controls because the increase induced by standing was smaller in migraine patients. The results in patients with migraine with aura (21 patients) and migraine without aura (41 patients) did not differ significantly from each other. The same was true for the results of the female and male patients.
It is concluded that sympathetic function is impaired in migraine patients.     

Visual Evoked Potential in Patients with Migraine

SYNOPSIS
Using pattern reversal stimuli, visual evoked potentials (VEP) were measured between attacks in 40 (6 classic and 34 common) migraine sufferers, and in 20 control subjects. While there were no statistically significant differences between the groups in mean P wave latency or in mean P wave amplitude, there were some intriguing individual findings in some of the migraine patients. Nine had P wave latencies more than 2 SD above the control mean; 6 had more than 2 SD increases above control in P wave amplitude; 3 had simultaneous increases in both latencies and amplitudes. In almost all the cases with these unusual values, the tracing had been done close in time to a migraine attack.