Premonitory Symptoms in Episodic and Chronic Migraine From a Pediatric Headache Clinic

Hypercoagulability may explain the increased risk of thromboembolic cerebrovascular events in patients with migraine. Thrombocytes play a crucial part in the coagulation process, and some studies have demonstrated hyperaggregation of thrombocytes in adult migraineurs. We aimed to compare thrombocyte count between pediatric patients with migraine or tension-type headache and to evaluate the correlation of thrombocyte count with headache parameters. The electronic database of a tertiary pediatric headache clinic was retrospectively searched for all children and adolescents diagnosed with migraine or tension-type headache in 2016-2018. Data on thrombocyte counts were collected from the medical files and compared between the groups by parametric and nonparametric statistical tests. The cohort included 299 patients, 176 girls (59.0%) and 123 (412.0%) boys, of mean age 12.2 ± 3.4 years; 198 had migraine and 101 had tension-type headache. Among the laboratory parameters evaluated, a significantly lower mean thrombocyte number was found in the migraine group than in the tension-type headache group (282 ± 60 vs 304±71 ×103/μL, P = .004). Within the migraine group, there was a significant negative correlation between the thrombocyte count and the duration of headache attacks in hours ( P < .05). No significant between- or within-group differences were found in other laboratory parameters. The low relative thrombocyte count in pediatric headache clinic patients with migraine and its negative correlation with duration of migraine suggest that migraine may be associated with a different underlying pathogenesis from tension-type headache.

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Living with chronic migraine: a qualitative study on female patients' perspectives from a specialised headache clinic in Spain

BMJ Open ◽

10.1136/bmjopen-2017-017851 ◽

2017 ◽

Vol 7 (8) ◽

pp. e017851 ◽

Cited By ~ 6

Author(s):

Domingo Palacios-Ceña ◽

Beatriz Neira-Martín ◽

Lorenzo Silva-Hernández ◽

Diego Mayo-Canalejo ◽

Lidiane Lima Florencio ◽

...

Keyword(s):

Qualitative Research ◽

Chronic Migraine ◽

Family Environment ◽

Drug Prescription ◽

Work And Family ◽

Self Control ◽

University Hospital ◽

Strong Impact ◽

Headache Clinic ◽

The Impact

ObjectivesThe aim of this study was to explore the views and experiences of a group of Spanish women suffering from chronic migraine (CM).SettingHeadache clinic at a university hospital in Madrid (Spain).ParticipantsPurposeful sampling of patients that attended a specialised headache clinic for the first time between June 2016 and February 2017 was performed. The patients included were females aged 18–65 and with positive diagnoses of CM according to the International Classification of Headache disorders (third edition, beta version), with or without medication overuse. Accordingly, 20 patients participated in the study with a mean age of 38.65 years (SD 13.85).DesignQualitative phenomenological study.MethodsData were collected through in-depth interviews, researchers’ field notes and patients’ drawings. A thematic analysis was performed following appropriate guidelines for qualitative research.ResultsFive main themes describing the significance of suffering emerged: (a) the shame of suffering from an invisible condition; (b) treatment: between need, scepticism and fear; (c) looking for physicians’ support and sincerity and fighting misconceptions; (d) limiting the impact on daily life through self-control; and (e) family and work: between understanding and disbelief. The disease is experienced as an invisible process, and the journey to diagnosis can be a long and tortuous one. Drug prescription by the physician is greeted with distrust and scepticism. Patients expect sincerity, support and the involvement of their doctors in relation to their disease. Pain becomes the main focus of the patient’s life, and it requires considerable self-control. The disease has a strong impact in the work and family environment, where the patient may feel misunderstood.ConclusionsQualitative research offers insight into the way patients with CM experience their disease and it may be helpful in establishing a more fruitful relationship with these patients.

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Right-to-left shunt is common in chronic migraine

Cephalalgia ◽

10.1111/j.1468-2982.2009.02002.x ◽

2009 ◽

Vol 30 (5) ◽

pp. 535-542 ◽

Cited By ~ 11

Author(s):

SJ Nahas ◽

WB Young ◽

R Terry ◽

A Kim ◽

T Van Dell ◽

...

Keyword(s):

General Population ◽

Chronic Migraine ◽

Tertiary Care ◽

Episodic Migraine ◽

Diagnostic Interview ◽

Neurological Symptoms ◽

Valsalva Manoeuvre ◽

Clinical Implications ◽

Severity Of Disease ◽

Headache Clinic

Our aim was to determine the prevalence of right-to-left shunt (RtLS) in patients with chronic migraine (CM), and to correlate the presence and grade of RtLS with aura and neurological symptoms, and duration and severity of disease. The prevalence of RtLS in migraine without aura is similar to that of the general population (between 20 and 35%). In migraine with aura, the prevalence is much higher (approximately 50%). The prevalence in CM, with or without aura, is unknown. Consecutive patients between the ages of 18 and 60 years with CM attending a tertiary care specialty headache clinic over an 8-week period were eligible. There were 131 patients in the study. A structured diagnostic interview was performed. Bubble transcranial Doppler with Valsalva manoeuvre determined RtLS presence and grade. Sixty-six percent (86/131) of patients had RtLS, a statistically significantly greater rate than those reported in the general population and in migraine with or without aura ( P < 0.001). There was no difference in RtLS rate or grade between those with and those without aura. Specific headache features and the presence of neurological symptoms were similar between those with and those without RtLS. Compared with both the general population and the episodic migraine population (with and without aura), patients with CM, with or without aura, are more likely to have RtLS. The clinical implications of our findings need to be determined.

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Trigeminal neuralgia in children and adolescents: Experience of a tertiary pediatric headache clinic

Headache The Journal of Head and Face Pain ◽

10.1111/head.14023 ◽

2020 ◽

Author(s):

Anna Brameli ◽

Ludmyla Kachko ◽

Tal Eidlitz‐Markus

Keyword(s):

Trigeminal Neuralgia ◽

Children And Adolescents ◽

Pediatric Headache ◽

Headache Clinic

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Telemedicine in a pediatric headache clinic

Neurology ◽

10.1212/wnl.0000000000005482 ◽

2018 ◽

Vol 90 (19) ◽

pp. e1702-e1705 ◽

Cited By ~ 12

Author(s):

William Qubty ◽

Irene Patniyot ◽

Amy Gelfand

Keyword(s):

San Francisco ◽

Cost Effective ◽

Family Satisfaction ◽

Clinic Visit ◽

Survey Study ◽

Daily Routine ◽

Patient Centered ◽

Pediatric Headache ◽

Headache Clinic

ObjectiveThe aim of this prospective study was to survey our patients about their experience with our clinic's telemedicine program to better understand telemedicine's utility for families, and to improve patient satisfaction and ultimately patient care.MethodsThis was a prospective survey study of patients and their families who had a routine telemedicine follow-up visit with the University of California San Francisco Pediatric Headache Program. The survey was administered to patients and a parent(s) following their telemedicine visit.ResultsFifty-one of 69 surveys (74%) were completed. All (51/51) patients and families thought that (1) telemedicine was more convenient compared to a clinic visit, (2) telemedicine caused less disruption of their daily routine, and (3) they would choose to do telemedicine again. The mean round-trip travel time from home to clinic was 6.8 hours (SD ± 8.6 hours). All participants thought telemedicine was more cost-effective than a clinic visit. Parents estimated that participating in a telemedicine visit instead of a clinic appointment saved them on average $486.ConclusionThis prospective, pediatric headache telemedicine study shows that telemedicine is convenient, perceived to be cost-effective, and patient-centered. Providing the option of telemedicine for routine pediatric headache follow-up visits results in high patient and family satisfaction.

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Prevalence of parafunctional habits and temporomandibular dysfunction symptoms in patients attending a tertiary headache clinic

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2010000300009 ◽

2010 ◽

Vol 68 (3) ◽

pp. 377-380 ◽

Cited By ~ 10

Author(s):

Yára Dadalti Fragoso ◽

Heloísa Helena Carvalho Alves ◽

Sidney Oliveira Garcia ◽

Alessandro Finkelsztejn

Keyword(s):

Chronic Migraine ◽

Orofacial Pain ◽

Outpatient Service ◽

Episodic Migraine ◽

Primary Headaches ◽

Further Training ◽

Analgesic Drugs ◽

Temporomandibular Dysfunction ◽

High Prevalence ◽

Headache Clinic

OBJETIVE: To investigate the most prevalent forms of headache in a tertiary outpatient service, and to assess the frequency of associated parafunctional habits and temporomandibular dysfunction symptoms (TMD). METHOD: All new patients referred to the Headache Outpatient Service in UNIMES during 2008 were prospectively assessed by the neurologist and the dental surgeon. RESULTS: Eighty new patients were assessed; chronic migraine and episodic migraine without aura were the most prevalent conditions, accounting for 66.3% of all cases. There was significantly higher use of analgesics/days for the chronic migraine patients. The prevalence of parafunctional habits was 47.5% and the prevalence of TMD symptoms was 35%. CONCLUSION: The high prevalence of primary headaches, parafunctional habits and TMD symptoms and the inadequate use of analgesic drugs suggest that primary healthcare units need further training in the field of headache and orofacial pain.

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Prevalence of cranial autonomic parasympathetic symptoms in chronic migraine: Usefulness of a new scale

Cephalalgia ◽

10.1177/0333102415593087 ◽

2015 ◽

Vol 36 (4) ◽

pp. 346-350 ◽

Cited By ~ 29

Author(s):

Nuria Riesco ◽

Angel I Pérez-Alvarez ◽

Laura Verano ◽

Carmen García-Cabo ◽

Juana Martínez-Ramos ◽

...

Keyword(s):

Chronic Migraine ◽

Nasal Congestion ◽

Primary Headaches ◽

Conjunctival Injection ◽

Autonomic Symptoms ◽

Cranial Autonomic Symptoms ◽

Eyelid Oedema ◽

Headache Clinic ◽

First Time ◽

New Criteria

Background Cranial autonomic symptoms (CAS) seem to appear in around half of migraine patients. Objective Our aim was to analyse the prevalence and profile of CAS, mainly of cranial autonomic parasympathetic symptoms (CAPS), in a series of patients with chronic migraine (CM) according the new criteria for autonomic symptoms in the current IHS classification. Patients and methods We recruited consecutive CM patients attending our headache clinic. Five CPAS were surveyed: lacrimation, conjunctival injection, eyelid oedema, ear fullness and nasal congestion. They were graded as 0 (absent), 1 (present and mild) and 2 (present and conspicuous); therefore the score in this CAPS scale ranges from 0 to 10 points. As a cranial autonomic sympathetic symptom (CSAS), we also asked about the presence of ptosis. Results We interviewed 100 CM patients. Their mean age was 45 years (18–63 years); 93 were females. Eighteen had no CAPS, while 82 reported at least one CAPS. There were only six patients with scores higher than 5, the mean and median CAPS being 2.1 and 2, respectively. Prevalence of CAPS was lacrimation (49%), conjunctival injection (44%), eyelid oedema (39%), ear fullness (30%) and nasal congestion (20%). Ptosis was reported by 42. Conclusion These results, by using for the first time an easy quantitative scale, confirm that (mild) CAPS are not the exception but the rule in CM patients. The score in this CAPS scale could be of help as a further endpoint in clinical trials or to be correlated with potential biomarkers of parasympathetic activation in primary headaches.

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Premonitory symptoms in migraine from China: A multi-clinic study of 4821 patients

Cephalalgia ◽

10.1177/0333102421997850 ◽

2021 ◽

pp. 033310242199785

Author(s):

Xiaolin Wang ◽

Ziming Yin ◽

Yajun Lian ◽

Yanmei Xu ◽

Yajie Li ◽

...

Keyword(s):

Coffee Consumption ◽

Brain Dysfunction ◽

Environment Change ◽

Related Factors ◽

Neck Stiffness ◽

Premonitory Symptom ◽

Change Environment ◽

Headache Clinic ◽

Premonitory Symptoms

Objective To observe the prevalence and characteristics of premonitory symptoms in Chinese migraineurs and explore their associations with migraine-related factors. Method Migraineurs who visited a tertiary headache clinic and one of nine neurology clinics between May 2014 and November 2019 were studied. Result Among the 4821 patients meeting the migraine criteria (International Classification of Headache Disorders, 3rd edition), 1038 (21.5%) patients experienced at least one premonitory symptom. The most common premonitory symptoms were neck stiffness, dizziness, yawning and drowsiness. The logistic regression analysis demonstrated that aura, photophobia, aggravation by routine physical activity, triggers, family history, depression, coffee consumption and physical exercise were associated with an increased probability of experiencing premonitory symptoms ( p ≤ 0.001). The premonitory symptoms of migraine with and without aura differ in prevalence and most common symptoms. The cluster analysis revealed pairwise clustering of the following premonitory symptoms: Photophobia/phonophobia, concentration change/dysesthesia, loquacity/overactivity, yawning/drowsiness, fatigue/dizziness, and mood change/irritability. The correlation analysis of triggers and premonitory symptoms revealed that temperature change, environment change, sleep disorder, activity and stress were related to multiple premonitory symptoms, and that food, light, menstruation, alcohol and odor were related to special premonitory symptoms ( p ≤ 0.001). Conclusion The prevalence of premonitory symptoms among migraineurs in China is 21.5%. Some factors influence the probability of experiencing premonitory symptoms. Paired premonitory symptoms in the clustering analysis may share similar origins. Certain triggers associated with multiple premonitory symptoms may induce brain dysfunction; however, other triggers that overlap with corresponding special premonitory symptoms may be premonitory symptoms or a form of premonitory symptom.

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Prevalence of right-to-left shunts on transcranial Doppler in chronic migraine and medication-overuse headache

Cephalalgia ◽

10.1177/0333102413497600 ◽

2013 ◽

Vol 34 (1) ◽

pp. 37-41 ◽

Cited By ~ 5

Author(s):

Song Guo ◽

Sarvnaz Shalchian ◽

Pascale Gérard ◽

Michael Küper ◽

Zaza Katsarava ◽

...

Keyword(s):

Chronic Migraine ◽

Transcranial Doppler ◽

Medication Overuse ◽

Medication Overuse Headache ◽

Episodic Migraine ◽

Severe Form ◽

Cross Sectional ◽

Headache Clinic ◽

Chronic Headaches ◽

Chronic Migraineurs

Background It was suggested that right-to-left shunt (RLS) may be highly prevalent in chronic migraine (CM) patients, indicating that patent foramen ovale (PFO) might be an aggravating and chronifying factor of migraine. Since a high proportion of chronic migraineurs also have medication-overuse headache (MOH), one may wonder if they have a more severe form of the disorder and more frequently a PFO. Objective The objective of this study is to determine the prevalence and grade of RLS in patients suffering from CM and MOH. Methods A cross-sectional multicenter study of air-contrast transcranial Doppler was conducted in 159 patients with CM ( n = 57) or MOH ( n = 102) attending a tertiary headache clinic. Results The prevalence of RLS in CM was 37% (11% large shunts) and in MOH patients 31% (13% large shunts). There was no difference between the two groups ( p = 0.49). Conclusion RLS prevalence in CM is within the upper range of those reported in episodic migraine without aura or in the general population, and not higher in MOH. PFO is thus unlikely to have a significant causal role in these chronic headaches.

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