Depression, Migraine With Aura and Migraine Without Aura: Their Familiality and Interrelatedness

Migraine is frequently comorbid with depression. There appear to be common aetiological factors for both disorders, but the aetiology of migraine within depressed patients, in particular the significance of aura, has been little studied. A large sample of concordantly depressed sibling pairs [the Depression-Network (DeNT) sample] was assessed as having migraine with aura (MA), migraine without aura (MoA), probable migraine or no migraine according to International Headache Society guidelines. Correlations between siblings' migraine status were used to assess the nature of familial liability to migraine. A multiple threshold isocorrelational model fit best, in which different syndromes are conceptualized as different severities of one underlying dimension rather than as having separate aetiologies. Thus, MA and MoA were found to be different forms of the same disorder, with MA occupying the more extreme end of the spectrum of liability. Implications for our understanding of the relationship between migraine and depression are discussed.

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A DESCRIPTIVE EPIDEMIOLOGICAL STUDY ON MIGRAINE

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2020.v13i8.38102 ◽

2020 ◽

pp. 92-95

Author(s):

POOJITHA MAMINDLA ◽

SHARANYA MOGILICHERLA ◽

DEEPTHI ENUMULA ◽

OM PRAKASH PRASAD

Keyword(s):

Observational Study ◽

Migraine With Aura ◽

Migraine Without Aura ◽

International Headache Society ◽

Pharmacological Therapy ◽

Prior Approval ◽

Study Population ◽

Inflammatory Drugs ◽

Male Patients ◽

Probable Migraine

Objective: The main objective was to carry out the observational study in migraine patients. Methods: A prospective observational study was conducted for 6 months in 415 migraine patients with the prior approval from the Institutional Ethical committee. A predesigned pro forma was used to collect data such as socio-demographics of the patients, different types of migraine, triggering factors, and prescription pattern. Results: Among 415 patients, the female patients (n=356, 86%) outnumbered male patients (n=95, 14%). The mean age of the study population was found to be 59±54 years. In our study, we found that migraine without aura (79%) was most common, followed by probable migraine without aura (13.3%), chronic migraines (5%), and migraine with aura (0.3%). Grading is done according to International Headache Society into 0, mild, moderate, and severe. Conclusion: Compared to migraine with aura, migraine without aura is mostly seen in females than males due to fluctuating hormone levels, rural area is most effected due to exposure to triggers. Management includes pharmacological and non-pharmacological. Pharmacological therapy included nonsteroidal anti-inflammatory drugs agents, Triptans, and prophylactic therapy, and adjunctive therapy also prescribed.

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Clinical Characteristics of Migraine in A Population-Based Twin Sample: Similarities and Differences Between Migraine with and Without Aura

Cephalalgia ◽

10.1046/j.1468-2982.1999.1903151.x ◽

1999 ◽

Vol 19 (3) ◽

pp. 151-158 ◽

Cited By ~ 16

Author(s):

M Kallela ◽

M Wessman ◽

M Färkkilä ◽

A Palotie ◽

M Koskenvuo ◽

...

Keyword(s):

Migraine With Aura ◽

Migraine Without Aura ◽

Clinical Characteristics ◽

Telephone Interview ◽

International Headache Society ◽

Epidemiological Data ◽

Population Based ◽

Unilateral Headache ◽

Chi Squared ◽

Similarities And Differences

Objective: To look into clinical differences between migraine with and without aura in a population-based sample of migraineurs. Background: Migraine presents in two major forms, migraine with and migraine without aura. With the exception of the aura phase, the clinical characteristics of these entities are very similar. Despite this, however, the recent epidemiological data underline differences between migraine with and without aura. We tried to examine whether other features besides the aura differ between these two major forms of migraine. Methods: We studied 321 twins suffering from migraine with aura and 166 twins with migraine without aura from the population-based Finnish Twin Cohort. Migraine was diagnosed according to the criteria of the International Headache Society (MS). Analysis was based on the combination of a mailed questionnaire and a telephone interview by a neurologist. Special attention was paid to differences between migraine with and without aura. Results: Some qualities of headaches differed between IHS defined migraine with and without aura. Unilateral headache (Chi-squared p=0.039) and photophobia (Chi-squared p=0.010) were more typical for migraine with aura, while nausea was more typical for migraine without aura (Chi-squared p=0.002). Duration of headache in migraine without aura was also longer man in migraine with aura (Mann-Whitney U-test 0.007). Conclusions: There are clinical differences between IHS defined migraine with and without aura; even the headache phase between the two entities differs. It is worthwhile distinguishing between them when looking for the elusive genes for these more common forms of migraine.

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Migraine With Aura and Migraine Without Aura: An Epidemiological Study

Cephalalgia ◽

10.1046/j.1468-2982.1992.1204221.x ◽

1992 ◽

Vol 12 (4) ◽

pp. 221-228 ◽

Cited By ~ 348

Author(s):

Birthe Krogh Rasmussen ◽

Jes Olesen

Keyword(s):

Migraine With Aura ◽

Migraine Without Aura ◽

International Headache Society ◽

Age Distribution ◽

Cross Sectional Study ◽

Lifetime Prevalence ◽

Headache Disorders ◽

Cross Sectional ◽

Visual Disturbances ◽

Precipitating Factor

In a cross-sectional study of headache disorders in a representative general population of 1,000 persons the epidemiology of migraine with aura (MA) and migraine without aura (MO) was analysed in relation to sex and age distribution, symptomatology and precipitants. The headache disorders were classified on the basis of a clinical interview as well as a physical and a neurological examination using the operational diagnostic criteria of the International Headache Society (IHS). Lifetime prevalence of MA was 5%, male:female ratio 1:2. Lifetime prevalence of MO was 8%, M:F ratio 1:7. Women, but not men, were significantly more likely to have MO than MA. Neither MA nor MO showed correlation to age in the studied age interval (25–64 years). Premonitory symptoms occurred in 16% of subjects with MA and in 12% with MO. One or more precipitating factor was present in 61% with MA and in 90% with MO. In both MA and MO the most conspicuous precipitating factor was stress and mental tension. Visual disturbances were the most common aura phenomenon occurring in 90% of subjects with MA. Aura symptoms of sensory, motor or speech disturbances rarely occurred without coexisting visual disturbances. The pain phase of MA fulfilled the criteria for MO of the IHS. Headache was, however, less severe and shorter lasting in MA than in MO. Onset at menarche, menstrual precipitation, menstrual problems, influence of pregnancy and use of oral contraceptives all showed some relationship with the presence of MO and less with MA. The present findings suggest that MA and MO share the pain phase. Among subjects with MA and MO, 50% and 62%, respectively, had consulted their general practitioner because of migraine. Selection bias in previous clinical studies is demonstrated by comparisons with the present unselected sample.

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Migraine Without Aura and Migraine with Aura Are Distinct Clinical Entities: A Study of Four Hundred and Eighty-Four Male and Female Migraineurs From the General Population

Cephalalgia ◽

10.1046/j.1468-2982.1996.1604239.x ◽

1996 ◽

Vol 16 (4) ◽

pp. 239-245 ◽

Cited By ~ 204

Author(s):

MB Russell ◽

BK Rasmussen ◽

K Fenger ◽

J Olesen

Keyword(s):

General Population ◽

Migraine With Aura ◽

Migraine Without Aura ◽

International Headache Society ◽

Age At Onset ◽

Age Groups ◽

Bright Light ◽

Expected Number ◽

Normal Distributions ◽

Precipitating Factor

The clinical characteristics of migraine without aura (MO) and migraine with aura (MA) were compared in 484 migraineurs from the general population. We used the criteria of the International Headache Society. The lifetime prevalence of MO was 14.7% with a M:F ratio of 1:2.2; that of MA was 7.9% with a M:F ratio of 1:1.5. The female preponderance was significant in both MO and MA. The female preponderance was present in all age groups in MA, but was first apparent after menarche in MO, suggesting that female hormones are an initiating factor in MO, but not likely so in MA. The age at onset of MO followed a normal distribution, whereas the age at onset of MA was bimodally distributed, which could be explained by a composition of two normal distributions. The estimated separation between the two groups of MA was at age 26 years among the females and age 31 years among the males. The observed number of persons with co-occurrence of MO and MA was not significantly different from the expected number. The specificity and importance of premonitory symptoms are questioned, but prospective studies are needed. Bright light was a precipitating factor in MA, but not in MO. Menstruation was a precipitating factor in MO, but not likely in MA. Both MO and MA improved during pregnancy. The clinical differences indicate that MO and MA are distinct entities.

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Migrainous Disorder and its Relation to Migraine Without Aura and Migraine with Aura. A Genetic Epidemiological Study

Cephalalgia ◽

10.1046/j.1468-2982.1996.1606431.x ◽

1996 ◽

Vol 16 (6) ◽

pp. 431-435 ◽

Cited By ~ 31

Author(s):

MB Russell ◽

J Olesen

Keyword(s):

Migraine With Aura ◽

Migraine Without Aura ◽

International Headache Society ◽

Large Population ◽

Population Based ◽

Population Based Study ◽

Female Ratio ◽

First Degree Relatives ◽

Increased Risk ◽

Male Female Ratio

Migrainous disorder was analysed in a large population-based study of 4000 forty-year-old males and females. All interviews were conducted by one physician and the diagnostic criteria of the International Headache Society were used. Of the 48 people with migrainous disorder, 40 had migrainous disorder without aura and 9 had migrainous disorder with aura One person had co-occurrence of migrainous disorder with and without aura. The lifetime prevalence of migrainous disorder was 2.5% with a male: female ratio of 1:1.2. The first-degree relatives of probands with migrainous disorder were blindly interviewed. Compared with the general population, first-degree relatives of probands with migrainous disorder without aura had a slightly but less increased risk of migraine without aura than first-degree relatives of probands with migraine without aura. First-degree relatives of probands with migrainous disorder with aura had no increased risk of migraine with aura. We conclude that migrainous disorder without aura in some people is a type of migraine without aura and in other people not. Migrainous disorder with aura may be unrelated to migraine with aura. œ

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Migraine With Aura and Migraine Without Aura Are Not Distinct Entities: Further Evidence From a Large Dutch Population Study

Twin Research and Human Genetics ◽

10.1375/twin.9.1.54 ◽

2006 ◽

Vol 9 (1) ◽

pp. 54-63 ◽

Cited By ~ 45

Author(s):

Lannie Ligthart ◽

Dorret I. Boomsma ◽

Nicholas G. Martin ◽

Janine H. Stubbe ◽

Dale R. Nyholt

Keyword(s):

Latent Class Analysis ◽

Migraine With Aura ◽

Migraine Without Aura ◽

Latent Class ◽

International Headache Society ◽

Neurological Symptoms ◽

Class Analysis ◽

Class 1 ◽

Screening Question ◽

Severe Type

AbstractIt is often debated whether migraine with aura (MA) and migraine without aura (MO) are etiologically distinct disorders. A previous study using latent class analysis (LCA) in Australian twins showed no evidence for separate subtypes of MO and MA. The aim of the present study was to replicate these results in a population of Dutch twins and their parents, siblings and partners (N = 10,144). Latent class analysis of International Headache Society (IHS)-based migraine symptoms resulted in the identification of 4 classes: a class of unaffected subjects (class 0), a mild form of nonmigrainous headache (class 1), a moderately severe type of migraine (class 2), typically without neurological symptoms or aura (8% reporting aura symptoms), and a severe type of migraine (class 3), typically with neurological symptoms, and aura symptoms in approximately half of the cases. Given the overlap of neurological symptoms and nonmutual exclusivity of aura symptoms, these results do not support the MO and MA subtypes as being etiologically distinct. The heritability in female twins of migraine based on LCA classification was estimated at .50 (95% confidence intervals [CI] .27 – .59), similar to IHS-based migraine diagnosis (h2 = .49, 95% CI .19–.57). However, using a dichotomous classification (affected–unaffected) decreased heritability for the IHS-based classification (h2 = .33, 95% CI .00–.60), but not the LCA-based classification (h2 = .51, 95% CI .23–.61). Importantly, use of the LCA-based classification increased the number of subjects classified as affected. The heritability of the screening question was similar to more detailed LCA and IHS classifications, suggesting that the screening procedure is an important determining factor in genetic studies of migraine.

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Sex-Hormone-Related Events in Migrainous Females. A Clinical Comparative Study Between Migraine With Aura and Migraine Without Aura

Cephalalgia ◽

10.1046/j.1468-2982.1995.015002140.x ◽

1995 ◽

Vol 15 (2) ◽

pp. 140-144 ◽

Cited By ~ 112

Author(s):

LM Cupini ◽

M Matteis ◽

E Troisi ◽

P Calabresi ◽

G Bernardi ◽

...

Keyword(s):

Oral Contraceptive ◽

Migraine With Aura ◽

Migraine Without Aura ◽

Contraceptive Use ◽

Sex Hormone ◽

Gonadal Hormone ◽

Oral Contraceptive Use ◽

Significant Difference ◽

First Time ◽

The Relationship

In this study, the relationship between hormonal-related events and migraine with aura (MA) and without aura (MO) was investigated. Subjects included 268 women suffering from MA (88) and MO (180). Data were collected on the relationship between sex-hormone-related events and migraine. Migraine during menses was observed in a significantly higher percentage of MO than MA patients ( p < 0.03). Menstrual migraine was significantly more common in MO than in MA patients ( p < 0.01). Migraine began during pregnancy in a significantly higher percentage of MA than of MO patients ( p < 0.01). No significant difference was observed between the two groups of patients regarding the onset of migraine at menarche, after menopause, in the postpartum period or during the early cycles of oral contraceptives. Also, both groups of patients showed a similar migraine course during pregnancy, oral contraceptive use and menopause. Eight patients with coexisting migraine with aura and migraine without aura attacks reported the appearance of the aura symptom for the first time in the early cycles of oral contraceptive intake. These findings suggest that gonadal hormone fluctuation may influence both types of migraine.

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Migraine Headaches in Adolescents: A Student Population-Based Study in Monreale

Cephalalgia ◽

10.1046/j.1468-2982.1995.1501005.x ◽

1995 ◽

Vol 15 (1) ◽

pp. 5-12 ◽

Cited By ~ 81

Author(s):

V Raieli ◽

D Raimondo ◽

R Cammalleri ◽

R Camarda

Keyword(s):

Migraine With Aura ◽

Migraine Without Aura ◽

International Headache Society ◽

Epidemiological Survey ◽

Population Based ◽

Student Population ◽

Population Based Study ◽

Migraine Headaches ◽

Ihs Classification ◽

Juvenile Population

We assessed the prevalence of migraine headaches in an epidemiological survey of an 11 to 14-year-old student population. Migraine headaches were classified on the basis of questionnaires and neurological examination using the operational diagnostic criteria of the International Headache Society. Prevalence of migraine without aura (IHS code 1.1) was 2.35%; that of migraine with aura (IHS code 1.2) was 0.62%. Migraine without aura was equally distributed among males and females, whereas migraine with aura was preponderant in the female cohort. The prevalence of migraine headaches in males was constant through the ages studied, whereas the prevalence of migraine headaches in females reached a peak at age 12 and plateaued over the following two years. Although the new IHS classification criteria of migraines are reliable and exhaustive, some subcriteria may not be valid in a juvenile population. For instance, the duration of the pain in young migraineurs is often briefer than in adults, and the intensity of pain was almost always described as moderate or severe. Therefore, in order to increase the reliability and comprehensiveness of the IHS classification, minor modifications should be made.

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Occupational Stress in Migraine is Weekend Headache a Myth or Reality?

Cephalalgia ◽

10.1046/j.1468-2982.1990.1004189.x ◽

1990 ◽

Vol 10 (4) ◽

pp. 189-193 ◽

Cited By ~ 10

Author(s):

DP Morrison

Keyword(s):

Occupational Stress ◽

Migraine With Aura ◽

Migraine Without Aura ◽

Ad Hoc ◽

International Headache Society ◽

Total Group ◽

Female Patients ◽

Emotional Factors ◽

Delayed Onset

To determine whether or not the frequency of migraine attacks increased at weekends in employed patients and if so, whether or not this was related to the type of migraine, 35 female patients prospectively recorded the presence or absence of migraine attacks daily over a six-week period. They were also asked to estimate the frequency with which emotional factors predisposed to their migraine attacks and to provide details of their occupation. A diagnosis of common (migraine without aura) or classical migraine (migraine with aura) was made according to both the criteria of the Ad Hoc Committee on the Classification of Headache and those of the International Headache Society. Eleven percent and 6% of patients, respectively, felt that emotional factors “usually” or “always” predisposed to migraine attacks. There was no significant increase in the frequency of migraine attacks at weekends in either the total group or in the employed patients. Similarly, the type of migraine made no difference to the results. There was therefore no evidence for a delayed onset of migraine at weekends related to the weekday stress of employment.

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Glyceryl Trinitrate Induces Attacks of Migraine Without Aura in Sufferers of Migraine with Aura

Cephalalgia ◽

10.1046/j.1468-2982.1999.019007660.x ◽

1999 ◽

Vol 19 (7) ◽

pp. 660-667 ◽

Cited By ~ 125

Author(s):

I Christiansen ◽

LL Thomsen ◽

D Daugaard ◽

V Ulrich ◽

J Olesen

Keyword(s):

Glyceryl Trinitrate ◽

Migraine With Aura ◽

Cortical Spreading Depression ◽

Migraine Without Aura ◽

Spreading Depression ◽

International Headache Society ◽

Pain Mechanisms ◽

Post Infusion ◽

Mean Time ◽

Messenger Molecule

Migraine with aura and migraine without aura have the same pain phase, thus indicating that migraine with aura and migraine without aura share a common pathway of nociception. In recent years, increasing evidence has suggested that the messenger molecule nitric oxide (NO) is involved in pain mechanisms of migraine without aura. In order to clarify whether the same is true for migraine with aura, in the present study we examined the headache response to intravenous infusion of glyceryl trinitrate (GTN) (0.5 μg/kg/min for 20 min) in 12 sufferers of migraine with aura. The specific aim was to elucidate whether an aura and/or an attack of migraine without aura could be induced. Fourteen healthy subjects served as controls. Aura symptoms were not elicited in any subject. Headache was more severe in migraineurs than in the controls during and immediately after GTN infusion ( p=0.037) as well as during the following 11 h ( p=0.008). In the controls, the GTN-induced headache gradually disappeared, whereas in migraineurs peak headache intensity occurred at a mean time of 240 min post-infusion. At this time the induced headache in 6 of 12 migraineurs fulfilled the diagnostic criteria for migraine without aura of the International Headache Society. The results therefore suggest that NO is involved in the pain mechanisms of migraine with aura. Since cortical spreading depression has been shown to liberate NO in animals, this finding may help our understanding of the coupling between cortical spreading depression and headache in migraine with aura.

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