The prevalence of metabolic syndrome parameters and their association with headache characteristics among migraineurs

Background: Migraine is associated with metabolic syndrome (MetS). There are evidences that components of MetS are more prevalent among migraine patients than non migraineurs. Since both migraine and MetS are associated with a high risk of cardiovascular events, it is likely that the parameters of MetS increase the occurrence of cardiovascular disease (CVD) in migraineurs. The present research project was conducted for the purpose of investigating the relationship between MetS parameters and different items of migraine headaches. Methods: This descriptive-analytical, cross-sectional study was performed on 240 migraineurs [according to International Headache Society (HIS) II criteria] within the 17+ age range. The participants were selected via consecutive and convenience sampling method. The evaluated parameters for each subject included 2 arms: migraine characteristics (intensity, frequency of attacks, subtype, duration, and treatment regimen) and indices of MetS according to the National Cholesterol Education Program’s Adult Treatment Panel III (NCEP ATP-III) report criteria [high-density lipoprotein-cholesterol (‎HDL-C), triglyceride (TG), fasting plasma glucose (FPG), height, waist circumference (WC), systolic and diastolic blood pressure (BP), and body mass index (BMI)]. All data were analyzed in SPSS software. Results: Total prevalence of MetS was 16.25% (39 patients). There was a statistically meaningful relationship between hypertriglyceridemia and gender (P = 0.021), hypertriglyceridemia and prophylactic antimigraine regimen (P = 0.022), hyperglycemia and age group (P = 0.010), hyperglycemia and the intensity of headache (P = 0.048), hyperglycemia and prophylactic treatment (P = 0.001), systolic hypertension and migraine subtype (P = 0.004), systolic hypertension and the duration of migraine disease (P = 0.005), diastolic hypertension and migraine subtype (P = 0.002), WC and gender (P = 0.001), WC and the intensity of headache (P = 0.028), WC and prophylactic medication (P = 0.017), HDL and gender (P = 0.001), HDL and the prophylactic regimen (P = 0.023), and MetS and gender (P = 0.005). The prevalence of MetS was increased with increase in the severity of migraine headache. Conclusion: Due to the relative increase in the prevalence of MetS in patients with more severe migraine, an evaluation of the mechanisms of MetS is recommended in this population.

Rhinogenic contact point headache in pediatric age group: a review

Headache is a common clinical entity of pediatric patients in routine clinical practice. Anatomical variation in the nasal cavity may result in headaches due to contact of the opposing mucosal surfaces, called rhinogenic contact point headache (RCPH). RCPH has recently begun to be of interest among clinicians and is accepted as a cause of headache by international headache society classification. The pressure of the two opposing mucosal surfaces in the nasal cavity without any evidence of inflammation can be an etiology for headache or facial pain. Anatomical variations in the nasal cavity like deviated nasal septum (DNS), spur, concha bullosa, hypertrophied inferior turbinate, medialized middle turbinate, and septal bullosa are important causes for contact point headache. RCPH is often misdiagnosed by clinicians during the assessment of headaches in pediatric patients and is sometimes considered a headache of unknown etiology. Endoscopic examination of the nasal cavity and computed tomography (CT) scans are important tools for the diagnosis of anatomical variations in the nasal cavity causing RCPH. Endoscopic resection of the contact point in the nasal cavity is the treatment of choice. There is not much literature for RCPH in pediatric patients, indicating that these clinical entities are neglected. This review article discusses the details of the epidemiology, etiopathology, clinical manifestations, diagnosis, treatment of the RCPH in pediatric patients.

Recurrent Painful Ophthalmoplegic Neuropathy: Diagnostic Controversies. Single Case Report with a Systematic Review

Background: Ophthalmoplegic migraine, renamed “Recurrent Painful Ophthalmoplegic Neuropathy (RPON) in 2013 by the International Headache Society is a rare neurologic disorder characterized by recurrent attacks of ophthalmoplegia associated to ipsilateral headache. The etiology is still unknown. Typical magnetic resonance imaging findings show a focal nerve thickening and contrast enhancement. In the majority of cases, there is a full recovery within days or weeks. There is no evidence supporting a specific treatment. The review defines the characteristics of the recurrent painful ophthalmoplegic neuropathy in patients within 2 years of age underlying the importance of the role of magnetic resonance imaging even in presence of the first attack. Thus, an emblematic case report is presented.Case presentation: The authors present a case of third cranial nerve paresis in a 17-month-old male child, presenting a neuroradiological pattern highly suggestive of schwannoma, aneurism or recurrent painful ophthalmoplegic neuropathy. Thus, a review of the literature with the pediatric casuistry of recurrent painful ophthalmoplegic neuropathy occurred within 2 years of age focusing on diagnostic considerations is presented. The authors highlight the importance to consider recurrent painful ophthalmoplegic neuropathy in presence of magnetic resonance imaging findings and clinical symptoms referable to aneurysm or schwannoma. Thus, the review defines the characteristics and the neuroradiological findings at the first RPON attack occurred under 2 years of age.Conclusion: Although two attacks are necessary, the review strongly suggests to consider recurrent painful ophthalmoplegic neuropathy even at the first attack, in presence of described characteristics and the aforementioned magnetic resonance imaging findings.

Altered brain network functional connectivity patterns in patients with vestibular migraine diagnosed according to the diagnostic criteria of the Bárány Society and the International Headache Society

Background Vestibular migraine (VM) is considered one of the most common causes of episodic central vestibular disorders, the mechanism of VM is currently still unclear. The development of functional nuclear magnetic resonance (fMRI) in recent years offers the possibility to explore the altered functional connectivity patterns in patients with VM in depth. The study aimed to investigate altered patterns of brain network functional connectivity in patients with VM diagnosed based on the diagnostic criteria of the Bárány Society and the International Headache Society, and hope to provide a scientific theoretical basis for understanding whether VM is a no-structural central vestibular disease, i.e., functional central vestibular disease with altered brain function. Methods Seventeen patients with VM who received treatment in our hospital from December 2018 to December 2020 were enrolled. Eight patients with migraine and 17 health controls (HCs) were also included. Clinical data of all patients were collected. Blood pressure, blood routine tests and electrocardiography were conducted to exclude other diseases associated with chronic dizziness. Videonystagmography, the vestibular caloric test, the video head impulse test and vestibular-evoked myogenic potentials were measured to exclude peripheral vestibular lesions. MRI was utilized to exclude focal lesions and other neurological diseases. All subjects underwent fMRI. The independent component analysis was performed to explore changes in intra- and inter-network functional connectivity in patients with VM. Results Among 17 patients with VM, there were 7 males and 10 females with an average age of 39.47 ± 9.78 years old. All patients had a history of migraine. Twelve (70.6%) patients had recurrent spontaneous vertigo, 2 (11.7%) patients had visually induced vertigo, and 3 (17.6%) patients had head motion-induced vertigo. All 17 patients with VM reported worsening of dizziness vertigo during visual stimulation. The migraine-like symptoms were photophobia or phonophobia (n = 15, 88.2%), migraine-like headache (n = 8, 47.1%), visual aura during VM onset (n = 7, 41.2%). 5 (29.4%) patients with VM had hyperactive response during the caloric test, and 12 (70.6%) patients had caloric test intolerance. Eleven (64.7%) patients had a history of motion sickness. Totally 13 independent components were identified. Patients with VM showed decreased functional connectivity in the bilateral medial cingulate gyrus and paracingulate gyrus within sensorimotor network (SMN) compared with HCs. They also showed weakened functional connectivity between auditory network (AN) and anterior default mode network (aDMN) compared with HCs, and enhanced functional connectivity between AN and the salience network (SN) compared with patients with migraine. Conclusion Patients with vestibular migraine showed obvious altered functional connectivity in the bilateral medial cingulate gyrus and paracingulate gyrus within the SMN. The median cingulate and paracingulate gyri may be impaired, the disinhibition of sensorimotor network and vestibular cortical network may result in a hypersensitivity state (photophobia/phonophobia). Altered functional connectivity between AN and DMN, SN may lead to increased sensitivity to vestibular sensory processing.

Polygenic risk provides biological validity for the ICHD-3 criteria among Finnish migraine families

Background Migraine is diagnosed using the extensively field-tested International Classification of Headache Disorders (ICHD-3) consensus criteria derived by the International Headache Society. To evaluate the criteria in respect to a measurable biomarker, we studied the relationship between the main ICHD-3 criteria and the polygenic risk score, a measure of common variant burden in migraine. Methods We used linear mixed models to study the correlation of ICHD-3 diagnostic criteria, underlying symptoms, and main diagnoses with the polygenic risk score of migraine in a cohort of 8602 individuals from the Finnish Migraine Genome Project. Results Main diagnostic categories and all underlying diagnostic criteria formed a consistent continuum along the increasing polygenic burden. Polygenic risk was associated with the heterogeneous clinical picture starting from the non-migraine headache (mean 0.07; 95% CI 0.02–0.12; p = 0.008 compared to the non-headache group), to probable migraine (mean 0.13; 95% CI 0.08–0.18; p < 0.001), migraine headache (mean 0.17; 95% CI 0.14–0.21; p < 0.001) and migraine with typical visual aura (mean 0.29; 95% CI 0.26–0.33; p < 0.001), all the way to the hemiplegic aura (mean 0.37; 95% CI 0.31–0.43; p < 0.001). All individual ICHD-3 symptoms and the total number of reported symptoms, a surrogate of migraine complexity, demonstrated a clear inclination with an increasing polygenic risk. Conclusions The complex migraine phenotype progressively follows the polygenic burden from individuals with no headache to non-migrainous headache and up to patients with attacks manifesting all the features of the ICHD-3 headache and aura. Results provide further biological support for the ICHD-3 diagnostic criteria.

Body Mass Index and Migraine: A Hospital-Based Study in Lahore

Background: Obesity and migraine are the most common disorders among general population that are linked with disability and impaired life quality. Though, several studies have investigated the relationship between obesity and migraine but yet there is no complete knowledge regarding association between BMI and migraine, particularly chronic migraine. Objective: The objective of the study was to find the association between body mass index and migraine. Material and Methods: It was a prospective study carried out at Neurology Outpatient Department of Lahore General Hospital, Lahore. Total of 545 patients with major complaint of headache were included after fulfilling “episodic migraine” (n=370) and “chronic migraine” (n=175) criteria according to International Headache Society (IHS) criteria. Results: Among 370 patients with episodic migraine (EM), 78.4% were females while among 175 patients with chronic migraine (CM), 81.1% were females. In EM group, the mean age of the patients was 41.72+21.35 years and in CM group, it was 45.80+15.79 years. In EM group, mean pain intensity was 4.6+2.41 and in CM group, mean pain intensity was 4.3+2.51. Among EM group patients, mean duration of headache was 4.85+5.17 days and among CM group patients, mean duration was 20.88+8.86 days. Mean BMI (Body Mass Index) of patients in EM groups was 22.91+3.89 while in CM groups was 24.43+3.43 (P=0.002). In EM group, 9.7% patients and in CM group, 6.3% patients were underweight (P=0.189). In EM group, 11.4% patients and in CM group, 30.3% patients were overweight (P=0.002). However, in EM group, only 1.3% patients and in CM group, 3.4% patients were obese (P=0.087). Multiple logistic regression analysis of chronic migraine group showed significant results (P <0.05) regarding headache days/month, BMI, overweight and obese. Conclusion: Study concluded that overweight and obesity were associated factors for migraine. Chronic migraine patients were more likely to have elevated BMI than the episodic migraine patients. Keywords: Body mass index, migraine, obesity, chronic, headache

Migraine and Its Association with Hyperactivity of Cell Membranes in the Course of Latent Magnesium Deficiency—Preliminary Study of the Importance of the Latent Tetany Presence in the Migraine Pathogenesis

So far, there is no consistent and convincing theory explaining the pathogenesis of migraines. Vascular disorders, the effect of oxidative stress on neurons, and the contribution of magnesium-calcium deficiencies in triggering cortical depression and abnormal glutaminergic neurotransmission are taken into account. However, there are no reliable publications confirming the role of dietary deficits of magnesium and latent tetany as factors triggering migraine attacks. The aim of the study was to evaluate the influence of latent magnesium deficiency assessed with the electrophysiological tetany test on the course of migraine. The study included: a group of 35 patients (29 women and six men; in mean age 41 years) with migraine and a control group of 24 (17 women and seven men; in mean age 39 years) healthy volunteers. Migraine diagnosis was based on the International Headache Society criteria, 3rd edition. All patients and controls after full general and neurological examination were subjected to a standard electrophysiological ischemic tetany test. Moreover, the level of magnesium in blood serum was tested and was in the normal range in all patients. Then, the incidence of a positive tetany EMG test results in the migraine group and the results in the subgroups with and without aura were compared to the results in the control group. Moreover, the relationship between clinical markers of spasmophilia and the results of the tetany test was investigated in the migraine group. As well as the relationship between migraine frequency and tetany test results. There was no statistically significant difference in the occurrence of the electrophysiological exponent of spasmophilia between the migraine and control group. Neither correlation between the occurrence of clinical symptoms nor the frequency of migraine attacks and the results of the tetany test was stated (p > 0.05). However, there was an apparent statistical difference between the subgroup of migraine patients with aura in relation to the control group (p < 0.05). The result raises hope to find a trigger for migraine attacks of this clinical form, the more that this factor may turn out to be easy to supplement with dietary supplementation.

Migraine and premenstrual syndrome: comorbid disorders?

IntroductionHeadache is a common symptom among women, including during the menstrual cycle. The migraine frequency in women who present migraine associated with the menstrual period ranges from 50% to 70%. Premenstrual syndrome (PMS) is prevalent among women, affecting 80% to 90% of them throughout their lives.ObjectiveThe objectives of this study were to verify PMS prevalence and its characteristics among women who present with cephalalgia in the neurology ambulatory care unit and show the prevalence of headache and its association with PMS in the gynecology ambulatory care unit.MethodsIt is a descriptive and qualitative study which was carried out at Emilio Carlos Teaching Hospital in the neurology and gynecology ambulatory care units with women aged 18 to 52 years old. Eighty-seven questionnaires were distributed and self-applied throughout the year of 2018 for data collection. Each questionnaire consisted of 27 questions about the life cycle of the women and their headache episodes. The diagnostic criteria for headache and migraine from the International Headache Society were used. Criteria for PMS were met according to the quality of life questionnaire.ResultsIn gynecology unit group, 9% of the women did not present headache, 76% had PMS and 94% presented with headache during PMS. In neurology, 79% of the women had PMS and 79% of the women who presented with cephalalgia also had PMS.ConclusionThere is a large percentage of PMS in both groups, i.e. neurological unit and gynecological unit, showing it is not a spurious correlation.

Clinical features of medication overuse headache following overuse of different acute symptomatic medications: A preliminary study

Background Medication overuse headache (MOH) is a growing problem worldwide and is defined as daily or near-daily headache in patients with a primary headache disorder who overuse acute medications. There is debate about whether there are differences in the clinical features and risks of MOH induced by different drugs. Here we investigated the clinical characteristics of patients with MOH following overuse of different acute headache drugs such as triptans and other medications.Methods A multicenter cross-sectional observation study, REgistry for Load and Management of MEdicAtion OveruSE Headache (RELEASE), prospectively collected demographic and clinical data from 114 consecutive patients with MOH according to the International Headache Society criteria between May 2020 and January 2021. We calculated the mean duration until onset of MOH from chronic daily headache (MDMOH), mean monthly frequency of severe headache (MMFSH), mean monthly frequency of seeking medical services (MMFMedS), and mean monthly intake frequency (MMIF) as well as headache impact and neuropsychological tests in patients with MOH after overuse of acute headache drugs.Results A total of 105 eligible MOH patients was included in this study. The patients showed overuse of triptans (31/105, 29.5%), ergotamines (8/105, 7.6%), simple or combination analgesics (37/105, 35.2%), opioids (1/105, 0.9%), and combination of two of more drugs (28/105, 26.7%). The MDMOH was significantly longer for the analgesics group (10.6 years) than the ergotamines (4.1 years), triptans (4.3 years), or multiple drugs group (4.8 years) (p = 0.011, Kruskal–Wallis test). The MMFMedS was lower for the analgesics group (0.37 days per month) than the multiple drugs (0.85 days) or triptans (0.58 days) group (p = 0.008, Kruskal–Wallis test). The MMFSH was significantly lower in the triptans group (7.4 days per month) than in the analgesics (14.4 days) or multiple drugs group (13.7 days) (p = 0.005, Kruskal–Wallis test). The MMIF was higher in the multiple drugs group (25 days per month) than the triptans (18.1 days) or analgesics (19.5 days) group (p = 0.007, Kruskal–Wallis test).Conclusion Data from this prospective multicenter study suggest that the clinical characteristics of MOH depend on the type of overused symptomatic headache medications.