[Mechanisms of pain and genetics in migraine].
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Humans↗
Biomedical subjects
M B Russell
Publications and source records attributed to M B Russell.
Genetic epidemiology of migraine and cluster headache.
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Adolescent↗
Genetic heterogeneity of migraine with and without aura in Danes cannot be explained by mutation in mtDNA nucleotide pair 11084.
INTRODUCTION: Migraine is a genetic heterogeneous disorder. The 11084 A to G base substitution is in the gene for the ND4 subunit of the respiratory complex I, and leads to a Thr to Ala amino acid replacement. This mutation had been found in 25% of Japanese migraineurs, while tension-type headache sufferers and non-migraineurs did not have it. MATERIAL AND METHODS: We investigated the importance of this mutation in Danish migraineurs without aura, migraineurs with aura and non-migraineurs from the general population. RESULTS: We did not detect this mutation in Danes. CONCLUSION: Our result excludes a significant role of this mutation in the etiology of migraine in Denmark, and its absence in non-migraineurs supports that this mutation is rare in non-Japanese populations.
Adult↗
[Prevalence and sex distribution of different forms of migraine].
The aim of this study was to provide prevalence and sex-ratio of subtypes of migraine diagnosed by neurological interview according to the criteria of the International Headache Society. In all, 3000 males and 1000 females aged 40 years were randomly selected from the Danish population. They received a mailed questionnaire regarding migraine. The questionnaire response rate was 87%. People with self-reported migraine and a random sample of those reporting no migraine were invited to a headache interview, and a physical and a neurological examination. Those not reacting to the invitation were interviewed by telephone. Participation in the interview was 87%. Kappa was 0.77 validating self-reported migraine in the questionnaire against the diagnosis of the clinical interview. Lifetime prevalences of migraine without aura, migraine with aura, migraine aura without headache, and migrainous disorder were 8%, 4%, 1% and 1% in males and 16%, 7%, 3% and 2% in females. Overall lifetime prevalence of any type of migraine was 18%, 12% in males and 24% in females. This is lower than the sum of the prevalences since migraine diagnoses are not mutually exclusive. The male:female ratios of migraine without aura, migraine with aura, migraine aura without headache, and migrainous disorder were approximately 1:2.
Adult↗
A comparison of tension-type headache in migraineurs and in non-migraineurs: a population-based study.
The prevalence, sex-ratio and clinical characteristics of tension-type headache were analyzed in 4000 people from the general population. The one-year-period prevalence of tension-type headache was not significantly different in people with migraine without aura (83%), in people with migraine with aura (75%) and in people who had never had migraine (76%). The male/female ratio varied from 1:1.19 to 1:1.23 and was not significantly different in the three subgroups. Tension-type headache was significantly more frequent within the last year and lasted longer in migraineurs than in people who had never had migraine. The pain characteristics and accompanying symptoms were very similar in the three subgroups. Tension-type headache was often precipitated by stress, mental tension and tiredness. Only migraineurs had episodes of tension-type headache precipitated by alcohol, over-matured cheese, chocolate and physical activity. We conclude that tension-type headache and migraine are separate disorders and not part of a continuum of headache disorders. However, migraine may aggravate and precipitate tension-type headache possibly due to convergence of various noxious peripheral input into the trigeminal nucleus.
Adult↗
The family history of migraine. Direct versus indirect information.
Migraine assessed by proband report was evaluated in a family study of migraine. A clinical interview of spouses and first-degree relatives by a physician was used as an index of validity. The operational diagnostic criteria of the International Headache Society were used. Of the 378 probands from the general population, 126 had migraine without aura, 127 had migraine with aura, 17 had both migraine without aura and migraine with aura and 108 had never had migraine. Spouses (n = 229) and first-degree relatives (n = 1109) were included in the analyses. Sensitivity, specificity, predictive values and chance-corrected agreement rate for the diagnosis of migraine were 49%, 93%, 81% (PVpos), 77% (PVneg) and 0.47, respectively. The corresponding values for migraine without aura were 58%, 87%, 63% (PVpos), 84% (PVneg) and 0.46 respectively, while the values for migraine with aura were 52%, 88%, 61% (PVpos), 83% (PVneg) and 0.42, respectively. Migraine assessed by proband report is not satisfactory for diagnosing migraine in relatives, since the number of affected relatives is highly underestimated. Our results emphasize the necessity of a clinical interview of the relatives in family studies of migraine.
Case-Control Studies↗
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.
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.
Adult↗
Migraine without aura and migraine with aura are inherited disorders.
The familial occurrence and mode of inheritance were analysed in families with migraine without aura (MO) and migraine with aura (MA). The probands were found among 4000 persons from the general population. All persons with MA were included as probands, and an equivalent number of probands with MO was selected as a random sample among those with MO. Spouses and first-degree relatives were blindly interviewed. All interviews were performed by one neurological research fellow. The distinct familial patterns indicate that MO and MA have a different aetiology. Compared with the general population, the first-degree relatives of probands with MO had a 1.9-fold increased risk of MO while spouses had a 1.5-fold increased risk of MO, indicating that both genetic and environmental factors are important in MO. The first-degree relatives of probands with MA had a four-fold increased risk of MA while spouses had no increased risk of MA, indicating that MA is determined largely by genetic factors. The complex segregation analysis indicated that both MO and MA have multifactorial inheritance without generational difference.
Adolescent↗
Migrainous disorder and its relation to migraine without aura and migraine with aura. A genetic epidemiological study.
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.
Adult↗
A nosographic analysis of the migraine aura in a general population.
The study presented here is the first detailed nosographic analysis of migraine aura, diagnosed using the criteria of the International Headache Society, in a sufficiently large sample for statistical analysis. Of 4,000 people, 163 had migraine with aura. Sixty-two had attacks of migraine aura with headache as well as migraine aura without headache, and seven had exclusively migraine aura without headache. Visual symptoms were most frequent (99%), followed by sensory (31%), aphasic (18%) and motor (6%) symptoms. Those with several types of aura symptoms had visual aura in virtually every attack, while sensory, motor and aphasic aura were present only in a small number of their attacks. The typical visual aura starts as a flickering, uncoloured, zig-zag line in the centre of the visual field and affect the central vision. It gradually progresses towards the periphery of one hemifield and often leaves a scotoma. The typical sensory aura is unilateral, starts in the hand, progresses towards the arm and then affects the face and tongue. The typical motor aura is half-sided and affects the hand and arm. The visual, sensory and aphasic auras rarely lasted > 1 h, while the motor aura did in 67% (six out of nine). Four people had exclusively acute onset visual aura. The duration of the aura and the characteristics of the ensuing headache were typical for migraine with aura, suggesting that acute onset aura is a real phenomenon. Headache followed the aura in 93%, headache and aura occurred simultaneously in 4% and aura followed headache in 3%. The characteristic spread of each symptom and the sequence of different symptoms suggest that cortical spreading depression is the mechanism underlying the migraine aura. Our results do not suggest that alterations of the diagnostic criteria of the International Headache Society are needed. The intra-individual variation of aura symptoms shown in this study indicates that a simplification of the International Classification of Diseases, Neurological Adaptation is appropriate.
Adult↗
Deciduous teeth in tuberous sclerosis.
Shed deciduous teeth from patients with tuberous sclerosis, cerebral palsy, Down syndrome, phenylketonuria and healthy persons were examined with a surface microscope. We found enamel pits in all 87 deciduous teeth from the 20 patients with tuberous sclerosis, but in none of the 253 deciduous teeth from 142 controls constituting patients with cerebral palsy, phenylketonuria and Down syndrome as well as healthy persons. Enamel pits always occurred in the facial surface of the central incisor, lateral incisor and canine, while the number of enamel pits in the other surfaces of the deciduous teeth varied from none to nine. Ground sections examined microscopically revealed an undisturbed pattern of incremental lines (Retzius striae) surrounding the pits. In five dental sacs from patients with tuberous sclerosis, microscopic examination showed that the inner surface of the operculum was remarkably more irregular than in control patients.
Adolescent↗
[Familial occurrence of cluster headache].
The familial occurrence of cluster headache was assessed in 421 probands with cluster headache, diagnosed according to the diagnostic criteria of the International Headache Society. The probands were from a neurological clinic and two departments of neurology. They received a mailed questionnaire regarding the presence of cluster headache among their relatives. All possibly affected relatives were interviewed by telephone. The questionnaire response rate was 88% (370/421). Seven probands belonged to three families. Familial occurrence of cluster headache was confirmed in 7% (25/366) of the families. Compared with the general population, first degree relatives of probands with cluster headache had a 14-fold increased risk of cluster headache, after standardization for sex and age. The second degree relatives had a twofold increased risk of cluster headache. The increased familial risk of cluster headache strongly suggests that cluster headache has a genetic cause.
Adult↗
Increased familial risk and evidence of genetic factor in migraine.
OBJECTIVE: To investigate familial occurrence of migraine with and without aura. DESIGN: Familial occurrence of migraine with and without aura among first degree relatives and spouses of probands with migraine with or without aura and those who had never had migraine. All interviews of first degree relatives and spouses were done blindly by a neurological resident. The operational diagnostic criteria of the International Headache Society were used. SETTING: General population from Copenhagen County. SUBJECTS: The 378 probands had 1109 first degree relatives and 229 spouses. MAIN OUTCOME MEASURES: Patterns of familial aggregation of migraine with and without aura as assessed by calculation of the population relative risk. RESULTS: Compared with the general population the first degree relatives of probands with migraine without aura had 1.9 times the risk of migraine without aura and 1.4 times the risk of migraine with aura. The first degree relatives of probands with migraine with aura had nearly four times the risk of migraine with aura and no increased risk of migraine without aura. The first degree relatives of probands who had never had migraine had no increased risk of migraine either with or without aura. Spouses of probands with migraine without aura had 1.4 times the risk of migraine without aura whereas spouses of probands with migraine with aura had no increased risk of migraine with aura. CONCLUSION: The different familial patterns indicate that migraine without aura and migraine with aura have a different aetiology. Migraine without aura seems to be caused by a combination of genetic and environmental factors whereas migraine with aura is probably determined largely or exclusively by genetic factors.
Adolescent↗
[Sumatriptan treatment of migraine in general practice. A randomized, double-blind, placebo-controlled cross-over study].
Two hundred and thirty migraineurs diagnosed by their general practitioners in accordance with their usual practice were included. The patients treated two migraine attacks at home by subcutaneous injection of sumatriptan or placebo and the alternative medication for the second attack (cross-over). When sumatriptan was compared to placebo, significantly more of the 209 evaluable patients reported headache relief at one hour (56% v 8%, p < 0.001) and two hours (62% v 15%, p < 0.001) after the first injection. Resolution of nausea, photophobia and phonophobia was significantly more common in patients on sumatriptan than on placebo (p < 0.001 for all comparisons). The adverse events were usually transient and of mild or moderate severity, although, three patients withdrew due to adverse events. Ninety-five percent of patients evaluated by a neurological research fellow met the International Headache Society's criteria for migraine. In general practice, sumatriptan taken subcutaneously using an autoinjector at home was an effective and well tolerated acute treatment for migraine.
Adolescent↗
Inheritance of migraine investigated by complex segregation analysis.
Migraine is the most common neurological disorder, affecting about 20% of adults. The mode of inheritance was analyzed in the two main types of migraine, migraine without aura (MO) and migraine with aura (MA), by complex segregation analysis using the computer program POINTER. We included 126 probands with MO and 127 probands with MA from the general population. First-degree relatives and spouses were blindly interviewed by a neurological research fellow. The complex segregation analysis indicated that both MO and MA have multifactorial inheritance without generational difference.
Adolescent↗
Prevalence and sex-ratio of the subtypes of migraine.
BACKGROUND: The aim of this study was to provide the prevalence and sex-ratio of subtypes of migraine diagnosed by neurological interview according to the criteria of the International Headache Society. METHODS: In all, 3000 males and 1000 females aged 40 years were randomly selected from the Danish population. They received a mailed questionnaire regarding migraine. The questionnaire response rate was 87%. People with self-reported migraine and a random sample of those reporting no migraine were invited to a headache interview, and a physical and a neurological examination. Those not reacting to the invitation were interviewed by telephone. Participation at the interview was 87%. Kappa was 0.77 validating self-reported migraine in the questionnaire against the diagnosis of the clinical interview. RESULTS: Lifetime prevalences of migraine without aura, migraine with aura, migraine aura without headache, and migrainous disorder were 8%, 4%, 1% and 1% in males and 16%, 7%, 3% and 2% in females. Overall lifetime prevalence of any type of migraine was 18%; 12% in males and 24% in females. This is lower than the sum of the prevalences since migraine diagnoses are not mutually exclusive. The male:female ratios of migraine without aura, migraine with aura, migraine aura without headache, and migrainous disorder were approximately 1:2. CONCLUSIONS: Migraine is more prevalent than previously thought. There was a significant preponderance in females of all the subtypes of migraine except migrainous disorder.
Adult↗
Cluster headache is an autosomal dominantly inherited disorder in some families: a complex segregation analysis.
We investigated the mode of inheritance of cluster headache in 370 families. The probands were from a neurological clinic in Jutland and two departments of neurology in Copenhagen County, Denmark. The criteria of the International Headache Society were used. The patterns of segregation of cluster headache were assessed by complex segregation analysis performed with the computer program POINTER. Of the 370 probands with cluster headache, 25 had 36 relatives with cluster headache. The segregation analysis suggests that cluster headache has an autosomal dominant gene (p < 0.10) with a penetrance of 0.30-0.34 in males and 0.17-0.21 in females. The gene is present in 3 to 4% of males and 7 to 10% of females with cluster headache. An autosomal dominant gene has a role in cluster headache in some families.
Adolescent↗
Familial occurrence of cluster headache.
The familial occurrence of cluster headache was assessed in 421 patients with cluster headache, diagnosed according to the operational diagnostic criteria of the International Headache Society. The patients were recruited from a neurological clinic and two departments of neurology, covering east central Jutland and Copenhagen County respectively. They received a mailed questionnaire regarding the presence of cluster headache among their first and second degree relatives. All possibly affected relatives were interviewed by telephone. The response rate to the questionnaire was 88% (370/421). Seven patients belonged to three families. A positive family history of cluster headache was found in 7% (25/366) of the families. Compared with the general population, the first and second degree relatives of the 370 patients with cluster headache had a 14-fold and twofold increase in the risk of having cluster headache after standardisation for sex and age. This increase in familial risk strongly suggests that cluster headache has a genetic cause.
Adult↗