Is Migraine Primarily a Metaboloendocrine Disorder?

Purpose of the Review

The goals of this review are to evaluate recent studies regarding comorbidity between migraine and different metabolic and endocrine disorders and to discuss the role of insulin resistance as a common pathogenetic mechanism of these diseases.

Recent Findings

Recently, several studies showed that migraine is associated with insulin resistance, a condition in which a normal amount of insulin induces a suboptimal physiological response. All the clinical studies that used the oral glucose tolerance test to examine insulin sensitivity found that, after glucose load, there is in migraine patients a significant increase of both plasmatic insulin and glucose concentrations in comparison with controls. On the contrary, no association was found between migraine and type 2 diabetes, while type 1 diabetes seems to have a protective effect in the disease. Obesity and hypertension were shown to be risk factors for both episodic and chronic migraine. Metabolic syndrome has been recently associated mainly with migraine with aura and is now considered a risk factor also for medication overuse headache. Finally, a bidirectional association between migraine and hypothyroidism has been recently demonstrated, suggesting that common genetic or autoimmune mechanisms underlie both diseases.

Summary

Recent studies showed that insulin receptor signaling and the related physiological responses are altered in migraine and may have a relevant pathogenic role in the disease. Further studies are warranted in order to better elucidate mechanisms underlying insulin resistance in migraine in order to develop new therapeutic strategies for this debilitating disease.

     

Permanent cardiac pacing for severe pallid breath-holding spells

We report the case of an infant affected by frequent episodes of loss of consciousness with the clinical features of pallid breath-holding attacks. Prolonged asystole, up to 26 seconds, was demonstrated by Holter monitoring. The patient was treated with permanent pacemaker implantation, followed by complete symptom resolution during a 26-month follow-up.     

Matryoshka procedure for Valve‐in‐Valve TAVI failure

Valve‐in‐valve transcatheter valve implantation (ViV‐TAVI) procedures for deteriorated bioprosthesis are an established therapeutic option for high‐risk patients. The presence of the fixed sewing ring of the bioprosthesis can hamper appropriate expansion of the TAVI. We present a case of a ViViV‐TAVI, as a salvage procedure for acute ViV‐TAVI failure.     

Investigating the genetic role of aquaporin4 gene in migraine

Aquaporin4 (AQP4) has an important role in water homeostasis of human brain and a dysfunction of AQP4 could induce pathological conditions in neuronal activity. The purpose of our work was to evaluate the association of polymorphisms in the AQP4 gene with the risk and the clinical features of migraine. A total of 293 migraineurs and 249 controls were involved in the study. They were genotyped for four single nucleotide polymorphisms (SNPs) of AQP4 gene. No significant difference in the distribution of AQP4 genotypic and allelic frequencies between cases and controls was found. In addition, haplotype analysis did not show any significant difference. Comparison of the clinical features of the disease according to different AQP4 genotypes showed no significant difference. Our data do not support the hypothesis that the AQP4 gene could represent a genetic susceptibility factor for migraine.     

Food and headache attacks. A comparison of patients with migraine and tension-type headache

BACKGROUND: The role of foods as headache precipitants is still matter of debate. Several studies reported that dietary constituents may precipitate migraine attacks. Some authors reported that also tension type headache attacks may be provoked by foods. The purpose of this study was to evaluate the role of foods as headache triggers in both groups of patients. METHODS: We compared the role of foods as headache trigger in patients with migraine and tension type headache. Three hundred and nine patients were involved in the study and divided into six groups: 1) migraine without aura, 2) migraine with aura, 3) episodic tension type headache, 4) chronic tension type headache, 5) migraine without aura associated with episodic tension type headache, 6) migraine without aura associated with chronic tension type headache. RESULTS: Approximately one third of the patients reported susceptibility to certain foods. The percentage of food sensitivity was not significantly different between patients with migraine or tension type headache. The foods more commonly reported as headache triggers were alcoholic drinks, chocolate and cheese. No difference in specific food sensitivity between groups was found. The comparison of food-sensitive with food non-sensitive patients showed no significant difference in the clinical features. CONCLUSIONS: Our study suggests that foods may trigger not only migraine but also tension type headache attacks.