Central 5-Ht Receptor Hypersensitivity in Migraine Without Aura

Cephalalgia ◽  
2003 ◽  
Vol 23 (1) ◽  
pp. 29-34 ◽  
Author(s):  
EM Cassidy ◽  
E Tomkins ◽  
T Dinan ◽  
O Hardiman ◽  
V O'Keane
Keyword(s):  
Migraine Without Aura ◽  
International Headache Society ◽  
Test Group ◽  
Significant Rise ◽  
Serum Prolactin ◽  
Healthy Female ◽  
Daily Headache ◽  
Ihs Criteria ◽  
Neuroendocrine Challenge ◽  
Prolactin Response

Serotonin has long been implicated as a key neurotransmitter in migraine. There is a dearth of research specifically examining 5-HT1A receptor sensitivity in migraine despite the importance of this receptor in regulating central serotonergic tone. In this study we examined the hypothesis that migraine without aura is associated with hypersensitivity of central 5-HT1A receptors, using a 5-HT1A neuroendocrine challenge drug and comparing serum prolactin responses between a test group with migraine and a matched group of healthy controls. Twelve female subjects fulfilling International Headache Society (IHS) criteria for migraine without aura were evaluated. Following an overnight fast, subjects presented for testing at 9am. An intravenous canula was inserted and serum prolactin was assessed at baseline and every 30 min for 3 h following a single dose of 30 mg oral buspirone, a 5-HT1A-receptor agonist. Subjects were assessed during the first 5 days of the menstrual cycle. No subjects were taking psychotropic medication or migraine prophylactic treatment. Patients with current or previous psychiatric disorder, daily headache or analgesic overuse were excluded. 16 healthy female volunteers matched for age and menstrual status were also evaluated and served as controls. There was no difference in baseline prolactin between groups. There was a significant rise in prolactin following buspirone in both groups. Subjects with migraine had a significantly increased prolactin response to buspirone (delta max) compared to controls ( P < 0.001). This study supports the hypothesis that migraine without aura is associated with a relative hypersensitivity of central 5-HT1A receptors. This is of relevance given the role of the 5-HT1A receptor in controlling raphe 5-HT tone and in the possible association between migraine and anxiety and depression.

Migraine without aura and migrainous disorder in children; International Headache Society (IHS) and revised IHS criteria

Cephalalgia ◽  
2000 ◽  
Vol 20 (7) ◽  
pp. 617-620 ◽  
Author(s):  
A Cano ◽  
E Palomeras ◽  
S Alfonso ◽  
D Ortega ◽  
P Sanz ◽  
...  
Keyword(s):  
Migraine Without Aura ◽  
International Headache Society ◽  
Ihs Criteria

Evaluation of Chronic Daily Headache—Comparison to Criteria for Chronic Tension-Type Headache

Cephalalgia ◽  
1992 ◽  
Vol 12 (6) ◽  
pp. 365-368 ◽  
Author(s):  
Seymour Solomon ◽  
Richard B Lipton ◽  
Lawrence C Newman
Keyword(s):  
Chronic Daily Headache ◽  
Medication Overuse ◽  
International Headache Society ◽  
Tension Type Headache ◽  
Chronic Tension Type Headache ◽  
Ihs Classification ◽  
Analgesic Medication ◽  
Daily Headache ◽  
Ihs Criteria ◽  
Type Headache

The purpose of this study was to evaluate the adequacy of the International Headache Society (IHS) criteria for chronic tension-type headache and, if appropriate, suggest modifications of the IHS classification. We evaluated 100 consecutive patients with chronic daily headache. Approximately two-thirds of our patients fulfilled the criteria for chronic tension-type headache. Most of the patients who failed to meet the criteria did so because they had more than one migrainous feature. Approximately 50% of patients took excessive amounts of analgesic medication. We conclude that the IHS criteria should be modified to include chronic daily headache evolving from migraine; subtypes with and without medication overuse should be distinguished.

Diagnosis of Migraine: Empirical Analysis of a Large Clinical Sample of Atypical Migraine (IHS 1.7) Patients and Proposed Revision of the IHS Criteria

Cephalalgia ◽  
2001 ◽  
Vol 21 (5) ◽  
pp. 584-595 ◽  
Author(s):  
JC Rains ◽  
DB Penzien ◽  
GL Lipchik ◽  
NM Ramadan
Keyword(s):  
Chronic Migraine ◽  
Diagnostic Criteria ◽  
Empirical Analysis ◽  
Clinical Sample ◽  
International Headache Society ◽  
Primary Headache ◽  
Homogeneous Group ◽  
Number Of Patients ◽  
Daily Headache ◽  
Ihs Criteria

The International Headache Society (IHS) diagnostic criteria for headache improved the accuracy of primary headache diagnoses, including migraine. However, many migraineurs receive an ‘atypical migraine’ diagnosis according to the IHS nosology (IHS 1.7), indicating that they approximate but do not fully meet all IHS criteria. This study characterized and sub-classified patients with atypical migraine. Within a clinical sample of 382 headache sufferers, 83 patients met IHS criteria for ‘atypical migraine’. Patients receiving the IHS 1.7 designation did not converge to form a homogeneous group. Rather, distinct and clinically relevant subgroups were empirically derived (e.g. migraine with atypical pain parameters, brief migraine, chronic migraine). The results call for revisions of the IHS diagnostic criteria for migraine that would minimize the number of patients receiving an atypical diagnosis. Revisions would include decreasing the minimum headache duration criteria from 4 h to 2 h, and developing a classification for ‘chronic migraine’ for migraine greater than 15 days per month. The proposed revision provides a means of diagnosing the daily and near-daily headache commonly observed in clinical populations.

Validation of diagnostic criteria for migraine in the Zürich longitudinal cohort study

Cephalalgia ◽  
1993 ◽  
Vol 13 (12_suppl) ◽  
pp. 47-53 ◽  
Author(s):  
Kathleen Ries Merikangas ◽  
Amy E Whitaker ◽  
Jules Angst
Keyword(s):  
Young Adults ◽  
General Population ◽  
Diagnostic Criteria ◽  
Migraine Without Aura ◽  
International Headache Society ◽  
Gastrointestinal Symptoms ◽  
Tension Type Headache ◽  
Peak Period ◽  
Systematic Assessment ◽  
Ihs Criteria

This paper reports the results of a systematic assessment of the validity of the specific diagnostic criteria for migraine without aura, as defined by the International Headache Society (IHS), in a longitudinal epidemiologic sample of young adults who were selected from the general population of Zürich, Switzerland. Systematic modification of each of the IHS criteria for migraine without aura yielded one-year weighted prevalence rates ranging from 24% for the unmodified IHS criteria to 9% for the most restrictive definition of migraine. The major implications of the findings for the IHS criteria are: (a) they provide adequate coverage to classify the majority of subjects with headache in the general population; (b) there is little overlap between migraine and tension-type headache, suggesting that the criteria define moderately independent subgroups; (c) the criteria for migraine without aura appear to be too unrestrictive for application in the community, particularly among young adults at the peak period of incidence of migraine; (d) the criteria for “aura” need more precise operationalization; and (e) models of validation of the diagnostic criteria suggest that Criterion D of the IHS criteria for migraine without aura should be modified to require both gastrointestinal symptoms and photophobia and phonophobia.

scholarly journals Post-traumatic headache

2009 ◽  
Vol 67 (1) ◽  
pp. 43-45 ◽  
Author(s):  
Hugo André de Lima Martins ◽  
Valdenilson Ribeiro Ribas ◽  
Bianca Bastos Mazullo Martins ◽  
Renata de Melo Guerra Ribas ◽  
Marcelo Moraes Valença
Keyword(s):  
Head Injury ◽  
Migraine Without Aura ◽  
International Headache Society ◽  
Tension Type Headache ◽  
Time Interval ◽  
Mild Head Injury ◽  
Ihs Classification ◽  
Ihs Criteria ◽  
Post Traumatic ◽  
Type Headache

The onset of post-traumatic headache (PTC) occurs in the first seven days after trauma, according to the International Headache Society (IHS) classification. The objective of this study was to evaluate the several forms of headache that appear after mild head injury (HI) and time interval between the HI and the onset of pain. We evaluated 41 patients with diagnosis of mild HI following the IHS criteria. Migraine without aura and the chronic tension-type headache were the most prevalent groups, occurring in 16 (39%) and 14 (34.1%) patients respectively. The time interval between HI and the onset of headache was less than seven days in 20 patients (48.7%) and longer than 30 days in 10 (24.3%) patients. The results suggest that PTC may arise after a period longer than is accepted at the present by the IHS.

Assessment of International Headache Society Diagnostic Criteria: A Reliability Study

Cephalalgia ◽  
1994 ◽  
Vol 14 (4) ◽  
pp. 280-284 ◽  
Author(s):  
M Leone ◽  
G Filippini ◽  
D D'Amico ◽  
M Farinotti ◽  
G Bussone
Keyword(s):  
Diagnostic Criteria ◽  
Medical Records ◽  
Migraine Without Aura ◽  
International Headache Society ◽  
Tension Type Headache ◽  
Kappa Statistics ◽  
Reliability Study ◽  
Ihs Criteria ◽  
Craniofacial Pain ◽  
Type Headache

In 1988 the International Headache Society (IHS) introduced new diagnostic criteria for headaches and craniofacial pain. Since headaches can be diagnosed solely on the basis of information provided by the patient, it is essential that the criteria are reproducible and consistent. phenomena to a form designed to reflect the IHS criteria. Interobserver concordance (kappa statistics) in the application of the diagnostic hemicrania; kappa = 0.88 for migraine; kappa = 0.75 for tension-type headache; (ii) “almost perfect” to “substantial” for the second digit migraine without aura; kappa = 0.71 for chronic tension-type headache; kappa = 0.66 for cluster headache-like disorder not fulfilling the eria. These results show that the IHS diagnostic criteria are satisfactorily applicable to high quality medical records abstracted by experienced.

Is Familial Hemiplegic Migraine a Hereditary form of Basilar Migraine?

Cephalalgia ◽  
1995 ◽  
Vol 15 (6) ◽  
pp. 477-481 ◽  
Author(s):  
J Haan ◽  
GM Terwindt ◽  
RA Ophoff ◽  
PLJM Bos ◽  
RR Frants ◽  
...  
Keyword(s):  
Blood Flow ◽  
Migraine Without Aura ◽  
International Headache Society ◽  
Familial Hemiplegic Migraine ◽  
Control Group ◽  
Artery Blood Flow ◽  
Hemiplegic Migraine ◽  
Ihs Criteria ◽  
Genetically Determined ◽  
Pathophysiologic Mechanisms

We studied aura symptoms in 83 patients from 6 unrelated families suffering from familial hemiplegic migraine. Fifty-five of the patients reported symptoms that allowed us to categorize them as basilar migraine (BM) patients, in accordance with the International Headache Society (IHS) criteria. In a control group of 33 patients suffering from migraine with aura and 33 patients suffering from migraine without aura, 9 patients complained of vertigo, and only one patient of diplopia during one of her attacks. None of these control patients fulfilled the IHS criteria for BM We suggest that familial hemiplegic migraine and BM may share certain pathophysiologic mechanisms, which may consist of a (genetically determined) disturbance of basilar artery blood flow.

Migraine without aura and migrainous disorder in children; International Headache Society (IHS) and revised IHS criteria

Cephalalgia ◽  
2000 ◽  
Vol 20 (7) ◽  
pp. 617-620 ◽  
Author(s):  
A Cano ◽  
E Palomeras ◽  
S Alfonso ◽  
D Ortega ◽  
P Sanz ◽  
...  
Keyword(s):  
Prospective Study ◽  
Migraine Without Aura ◽  
International Headache Society ◽  
Tension Headaches ◽  
Ihs Criteria ◽  
Increased Sensitivity ◽  
Time Required ◽  
A Prospective Study ◽  
Headache Patients

The widely used criteria of the IHS to define migraine without aura in children are highly specific but show poor sensitivity, with a large percentage of headaches being classified as migrainous disorder (MD). The objective of this study was to assess how many headache patients in a series of children met the diagnostic criteria of the IHS for migraine without aura or MD and to determine the changes required to convert the greatest number of MD into migraine without aura, without affecting classification of the remaining headache types. A prospective study was undertaken of 131 patients under 15 years old referred to our centre for headache. Patients were classified according to the IHS criteria and according to a modification of these criteria consisting of: (1) reduction of minimum time required for classification into migraine without aura from 2 h to 1 h; (2) acceptance of bifrontal location in addition to hemicranial; (3) acceptance of either phonophobia or photophobia as valid criteria instead of requiring presence of both. Using the IHS criteria, 51 (39%) children were diagnosed as having migraine without aura and 26 (20%) as having MD. According to our revised IHS criteria, 68 (52%) were diagnosed as migraine without aura and nine (7%) as MD. When the three modified criteria were applied, three tension headaches and one unclassifiable headache changed category. When only reduced duration and bifrontal location were applied, none of the headaches other than MD changed category. Application of two modifications to the IHS criteria—reduction in duration of headache to 1 h and acceptance of bifrontal location—increased sensitivity without reducing specificity in classifying migraine without aura in children.

Schmerztherapie

2009 ◽  
Vol 28 (07) ◽  
pp. 440-447
Author(s):  
S. Evers
Keyword(s):  
Chronic Daily Headache ◽  
International Headache Society ◽  
Wird Eine ◽  
Neuropathische Schmerzen ◽  
Neue Substanzen ◽  
Daily Headache

ZusammenfassungIn diesem Artikel wird eine aktuelle Übersicht über die Prinzipien der modernen Schmerztherapie gegeben. Folgende Neuerungen der letzten Jahre sind von besonderer Bedeutung. Bei der Therapie chronischer Schmerzen erzielt die Kombination medikamentöser und nicht medikamentöser Maßnahmen die besten Erfolge. Der Einsatz von Opioiden kann unter Beachtung der evidenzbasierten Leitlinien auch bei Nichttumorschmerzen erfolgen. Die neuen Opioide sind nebenwirkungsärmer geworden, insbesondere im gastrointestinalen Bereich. Neuerdings steht ein spezifisches Naltrexon-Analogon zur Behandlung der opioidinduzierten Obstipation zur Verfügung. Neue Substanzen gegen neuropathische Schmerzen sind Oxcarbazepin, Pregabalin, Duloxetin und Lacosamid. Akupunktur bei chronischen Schmerzen ist besser als Warteliste. Für die Diagnostik von Kopfschmerzen ist 2004 eine neue Klassifikation der International Headache Society erschienen. Vor allem das Konzept des Chronic Daily Headache ist dabei weiterentwickelt worden. In der Attackenbehandlung der Migräne erzielt der frühzeitige Einsatz von Triptanen den besten Therapieerfolg. Eine Kombination von Triptanen und NSAR ist in Einzelfällen insbesondere beim Wiederkehrkopfschmerz sinnvoll. Substanzen der ersten Wahl in der Migräneprophylaxe sind die Betablocker Propranolol und Metoprolol, Flunarizin, Valproat und Topiramat.

Chronic Tension-Type Headache in Children and Adolescents

Cephalalgia ◽  
2001 ◽  
Vol 21 (8) ◽  
pp. 830-836 ◽  
Author(s):  
Ishaq Abu-Arafeh
Keyword(s):  
Children And Adolescents ◽  
Clinical Features ◽  
Chronic Daily Headache ◽  
Adult Population ◽  
Tension Type Headache ◽  
Stressful Events ◽  
Chronic Tension Type Headache ◽  
Daily Headache ◽  
Ihs Criteria ◽  
Type Headache

In this study, the causes, predisposing factors and clinical features of chronic daily headache in children and adolescents were studied within the population of patients attending a specialist headache. The International Headache Society's (IHS) criteria for the diagnosis of chronic tension type headache (CTTH) were assessed for their applicability in the paediatric age group. Over a period of three years, demographic and clinical data were collected prospectively on all children who attended the clinic and suffered from daily attacks of headache. One hundred and fifteen children and adolescents (32% of all clinic population) had chronic daily headache, of whom 93 patients (81%) fulfilled the IHS criteria for the diagnosis of CTTH. They were between 3-15 years of age (mean: 11.1, SD: 2.3) and their female to male ratio was 1.2: 1. Around one third of the patients also suffered from migraine (mainly migraine without aura). The headache was described as mild in 60.9%, moderate 36.5% and severe 2.6%. Headache was located at the forehead in 53% or over the whole of the head in 29.6%. Pain was described as ‘just sore’ or dull by 73.9%. During attacks of headache, at least half the patients reported light intolerance, noise intolerance, anorexia or nausea. Thirty-two percent of patients had at least one underlying chronic disease that may have contributed to the pathogenesis of the CTTH. Eleven percent had serious stressful events related to family illnesses and in four patients headaches were triggered by family bereavement. Fourteen percent were investigated with neuroimaging and 22% were referred for clinical psychology assessment and management. In conclusion, CTTH is a common cause of headache in children attending a specialist headache clinic. The clinical features closely match those of adult population and the IHS criteria for the diagnosis of CTTH can be adapted for use in children. Predisposing stressful risk factors, physical or emotional, are present in a large proportion.

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