Prevalence and impact of visual aura in migraine and probable migraine: a population study

Visual aura (VA) presents in 98% of cases of migraine with aura. However, data on its prevalence and impact in individuals with migraine and probable migraine (PM) are limited. Data from the nation-wide, population-based Circannual Change in Headache and Sleep Study were collected. Participants with VA rating scale scores ≥ 3 were classified as having VA. Of 3,030 participants, 170 (5.6%) and 337 (11.1%) had migraine and PM, respectively; VA prevalence did not differ between these cohorts (29.4% [50/170] vs. 24.3% [82/337], p = 0.219). Participants with migraine with VA had a higher headache frequency per month (4.0 [2.0–10.0] vs. 2.0 [1.0–4.8], p = 0.014) and more severe cutaneous allodynia (12-item Allodynia Symptom Checklist score; 3.0 [1.0–8.0] vs. 2.0 [0.0–4.8], p = 0.046) than those without VA. Participants with PM with VA had a higher headache frequency per month (2.0 [2.0–8.0] vs. 2.0 [0.6–4.0], p = 0.001), greater disability (Migraine Disability Assessment score; 10.0 [5.0–26.3] vs. 5.0 [2.0–12.0], p < 0.001), and more severe cutaneous allodynia (12-item Allodynia Symptom Checklist score, 2.5 [0.0–6.0] vs. 0.0 [0.0–3.0], p < 0.001) than those without VA. VA prevalence was similar between migraine and PM. Some symptoms were more severe in the presence of VA.

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.

Association of Genetic Variants With Migraine Subclassified by Clinical Symptoms in Adult Females

Migraine is heritable and formally diagnosed by structured criteria that require presence of some but not all possible migraine symptoms which include aura, several distinct manifestations of pain, nausea/vomiting, and sensitivity to light or sound. The most recent genome-wide genetic association study (GWAS) for migraine identified 38 loci. We investigated whether 46 single-nucleotide polymorphisms (SNPs), i.e., genetic variants, at these loci may have especially pronounced, i.e., selective, association with migraine presenting with individual symptoms compared to absence of migraine. Selective genetic associations of SNPs were evaluated through a likelihood framework in the Women's Genome Health Study (WGHS), a population-based cohort of middle-aged women including 3,003 experiencing migraine and 18,108 not experiencing migraine, all with genetic information. SNPs at 12 loci displayed significant selective association for migraine subclassified by specific symptoms, among which six selective associations are novel. Symptoms showing selective association include aura, nausea/vomiting, photophobia, and phonophobia. The selective associations were consistent whether the women met all formal criteria for diagnostic for migraine or lacked one of the diagnostic criteria, formally termed probable migraine. Subsequently, we performed latent class analysis of migraine diagnostic symptoms among 69,861 women experiencing migraine from the WGHS recruitment sample to assess whether there were clusters of specific symptoms that might also have a genetic basis. However, no globally robust latent migraine substructures of diagnostic symptoms were observed nor were there selective genetic associations with specific combinations of symptoms revealed among weakly supported latent classes. The findings extend previously reported selective genetic associations with migraine diagnostic symptoms while supporting models for shared genetic susceptibility across all qualifying migraine at many loci.

Prevalence and characteristics of cutaneous allodynia in probable migraine

Cutaneous allodynia (CA) is a pain in response to non-nociceptive stimulation and a marker of central sensitisation. Probable migraine (PM) is a migraine subtype that fulfils all but one criterion of migraine. Headache intensity and the disability of individuals with PM are similar or lower than individuals with migraine. This study compared CA prevalence and characteristics of PM and migraine using a nationally representative sample in Korea. The Allodynia Symptom Checklist-12 (ASC-12) was used to assess CA (ASC-12 score ≥ 3). PM and migraine prevalence were 11.6% and 5.0%, respectively. CA prevalence did not significantly differ between PM and migraine (14.5% vs. 16.0%, p = 0.701). Participants with PM with CA reported a higher monthly headache frequency (3.3 ± 4.3 vs. 1.8 ± 3.6, p = 0.044), more severe headache intensity (Visuals Analogue Scale, 6.0 [4.0–7.0] vs. 5.0 [3.0–6.0], p = 0.002), and higher impact of headache (Headache Impact Test-6, 56.3 ± 7.2 vs. 48.3 ± 8.0, p < 0.001) than those without CA. Multiple regression analyses revealed that headache frequency and intensity, anxiety, and depression were significant factors for CA in participants with PM. In conclusion, CA prevalence among participants with PM and migraine were comparable. Anxiety, depression, and headache frequency and intensity were significant factors for CA in participants with PM.

Ponytail headache (external-traction headache): prevalence, characteristics and relationship with migraine

IntroductionDespite its frequent occurrence, external-traction headache (previously named as “ponytail headache”) is scarcely documented in the literature.ObjectiveIn the present study we set out to estimate the prevalence of ponytail headache and its relationship with migraine.MethodsOne hundred and thirty women (27.7±11.1 years of age), 108 of them reported a previous history of primary headache [81/130 (62.3%) migraine or probable migraine and 27/130 (20.8%) non-migraine headache; 22/130 (16.9%) did not report any previous episode of headache], were requested to wear a ponytail for 60 minutes, removing it only in case of pain. When pain occurred, it was recorded for the latency between the placement of the ponytail and the onset of the pain, its duration and characteristics. The women also filled out a questionnaire on previous headache episodes.ResultsDuring the 60 minute-period, 52/130 (40%) women had ponytail headache elicited by the experiment. There was a higher prevalence of ponytail headache in those who reported previous episodes of primary headache [48/108 (44.4%)], compared to those who did not [4/22 (18.2%)] (p=0.022). The migraineurs had more ponytail headache than non-migraneurs [39/81 (48.2%) versus 9/27 (33.3%), p=0.180] with a positive history of primary headache and they also had more than those without [4/22 (18.2%)] (p=0.012). The group of women with migraine also presented more ponytail-induced headache than non-migraineurs combined with the groupof individuals without a previous history of headache [13/49 (26.5%), OR 2.57, 95%CI 1.19-5.55; p=0.015]. Migraine-like episodes were trigged in 3/52 (5.8%) by the experiment, all three migraineurs. The latency time for the beginning of ponytail headache during the experiment was 21.5 ± 15.4 min and the duration was 76.0±159.3 min.ConclusionThe prevalence of ponytail headache in our study was 40% and was statistically higher in migraineurs.

Physical inactivity and headache disorders: cross-sectional analysis in the Brazilian longitudinal study of adult health (ELSA-Brasil)

BackgroundPhysical inactivity has been linked to headache disorders, but data regarding the current recommended leisure-time (LTPA) and commuting physical activity (CPA) levels is unknown.ObjectiveTo test the associations between headache disorders (definite and probable migraine tension type headache-TTH) and physical inactivity in these domains (LTPA and CPA) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).MethodsIn a cross-sectional analysis, logistic regression models computed the odds ratio (OR) for the relationship between headache disorders and physical activity (LTPA and CPA) in the following levels: “active” (Reference), “insuciently active”, and “inactive”. The full models were controlled for the effects of sociodemographic data, cardiovascular risk profile, and use of headache medication (migraine prophylaxis)ResultsOf 15,0105 participants, 14,847 (45.6 % of men and 54.4 % women) responded the baseline interviews regarding physical activity levels and headache disorders. Overall, most significant physical inactivity was observed in LTPA domain for definite migraine [OR: 1.32 (1.10-1.57)] and probable migraine [OR: 1.33 (1.17-1.50)]. Similar findings were replicated by sex. Physical inactivity (LTPA) was positively associated with definite migraine in women [OR: 1.29 (1.04-1.59)], probable migraine in both men [OR: 1.40 (1.15-1.69)] and women [OR: 1.29 (1.04-1.59)]. Physical inactivity in CPA domain was associated to increased OR for probable TTH in men [OR: 1.33 (1.01-1.75)], while CPA was inversely associated to definite migraine [OR: 0.79 (0.64-0.98)] and probable migraine [OR: 0.80 (0.67-0.96)] in women. Considering all headaches, unmet vigorous physical activity levels were associated to increased OR for definite migraine [OR: 1.36 (1.13-1.65)] and probable migraine [OR: 1.37 (1.20-1.57)]. Finally, we found higher odds for daily headaches among LTPA-inactive [OR: 1.73 (1.20-2.49)] and CPA-insufficiently active [ OR: 1.36 (1.04-1.79)] participants.ConclusionPhysical inactivity is associated with headache disorders in the ELSA-Brasil study, with distinct associations regarding headache subtype, sex, physical activity domain and intensity, and headache frequency.

Prevalence and Characteristics of Cutaneous Allodynia in Migraine and Probable Migraine: A Population-Based Study

Background: Cutaneous allodynia (CA) is a common feature of migraine and a clinical marker of central sensitization. Probable migraine (PM) is a subtype of migraine that fulfils all but one criterion of migraine. The present study aimed to evaluate the prevalence and characteristics of CA and those of migraine in PM. Methods: We used the data of the Korean Sleep-Headache study, which was a nation-wide population-based study on headache and sleep. CA was evaluated using the Allodynia Symptom Checklist-12 (ASC-12) questionnaire with ASC-12 score ≥ 3 classified as CA. Results: Of 2501 participants, the prevalence of migraine and PM were 5.0% and 11.6%, respectively. The prevalence of CA did not significantly differ between migraine and PM (16.0% vs. 14.5%, respectively, p = 0.701). Individuals with PM with CA reported a higher monthly frequency of headache (3.3 ± 4.3 vs. 1.8 ± 3.6, respectively, p = 0.044), more severe intensity of headache (Visuals Analogue Scale, median and interquartile range, 6.0 [4.0–7.0] vs. 5.0 [3.0–6.0], respectively, p = 0.002), and higher impact of headache (Headache Impact Test-6, 56.3 ± 7.2 vs. 48.3 ± 8.0, respectively, p < 0.001) and disability (Migraine Disability Assessment, 1.00 [0.00–10.00] vs. 0.00 [0.00–1.00], respectively, p < 0.001) than individuals with PM without CA. Multiple regression analyses revealed that the frequency and intensity of headache, anxiety, and depression were significant factors of CA in individuals with PM. Conclusions: Approximately one-sixth of individuals with migraine and PM experienced CA in a representative sample of Korea. Anxiety, depression, and high frequency of headaches were significant factors of CA in individuals with PM.

A DESCRIPTIVE EPIDEMIOLOGICAL STUDY ON 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.

Headache associated with head trauma

Traumatic brain injury (TBI) is an extremely important, common global health issue with approximately 2.5 million TBIs occurring yearly in the civilian population alone. The symptom manifestations of TBI are called ‘concussion’ symptoms and headache is the most common. Post-traumatic headache (PTH) is a secondary headache occurring in temporal association with the TBI and thought to be caused by the injury. Many studies have found PTH to be frequent and persistent, with a higher prevalence of PTH after mild than moderate to severe TBI. In both severity injuries, the most frequent phenotype of PTH is migraine or probable migraine. PTH risk factor after injury is a prior history of primary headache disorder. The relationship between TBI and PTH is unknown and currently the subject of intense research. As yet, treatment of PTH is empiric with standard of care to ‘phenotype’ the headache according to primary headache clinical characteristics and use the type as a guideline for management.