Migraine and cardiovascular disease: is there a link?
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Comment↗
Biomedical subjects
Marcelo E Bigal
Publications and source records attributed to Marcelo E Bigal.
Obesity is a risk factor for transformed migraine but not chronic tension-type headache.
OBJECTIVE: To assess the influence of the body mass index (BMI) on the prevalence and severity of chronic daily headache (CDH) and its most frequent subtypes, transformed migraine (TM) and chronic tension-type headache (CTTH). METHODS: The authors gathered information on headache, medical features, height, and weight using a computer-assisted telephone interview. Participants were divided into five categories, based on BMI: underweight (<18.5), normal weight (18.5 to 24.9), overweight (25 to 29.9), obese (30 to 34.9), and morbidly obese (>35). The prevalence and severity of CDH, TM, and CTTH were assessed. Multivariate analyses modeling these diagnoses as a function of BMI were conducted. RESULTS: Among 30,215 participants, the prevalence of CDH was 4.1%; 1.3% had TM and 2.8% CTTH. In contrast with the normal weight group (3.9%), the prevalence of CDH was higher in obese (5.0% [odds ratio (OR) = 1.3, 95% CI = 1.1-1.6]) and morbidly obese (6.8% [OR = 1.8, 95% CI = 1.4 to 2.2]). BMI had a strong influence on the prevalence of TM, which ranged from 0.9% of the normal weighted to 1.2% of the overweight (OR = 1.4 [1.1 to 1.8]), 1.6% of the obese (OR = 1.7 [1.2 to 2.43]), and 2.5% of the morbidly obese (OR = 2.2 [1.5 to 3.2]). The effects of the BMI on the prevalence of CTTH were just significant in the morbidly obese group. Adjusted analyses showed that obesity was associated with CDH and TM but not CTTH. CONCLUSIONS: Chronic daily headache and obesity are associated. Obesity is a stronger risk factor for transformed migraine than for chronic tension-type headache.
Adolescent↗
Age-dependent prevalence and clinical features of migraine.
BACKGROUND: Available data suggest two seemingly opposite trends with regard to the natural history of migraine. Migraine prevalence decreases with age. In some individuals, migraine progresses to chronic daily headache. OBJECTIVE: To contrast the clinical features of migraine across the life span. METHODS: A validated computer-assisted telephone interview (CATI) was used to identify a population sample in three urban centers in the United States. Eligible participants were older than 18 years. The CATI covered the International Classification of Headache Disorders criteria for migraine and probable migraine (PM). Prevalence and clinical features of migraine and PM were examined by age. RESULTS: This sample consists of 145,335 participants. The overall prevalence of migraine was 15%, whereas the overall prevalence of PM was 14.6%. Migraine prevalence was highest between ages 30 and 39 years. In older ages, PM was more prevalent than migraine. Among those with migraine, the prevalence of unilateral and throbbing pain peaked at intermediate ages and declined after that. The prevalence of photophobia and phonophobia related to the attacks declined with ages, whereas the prevalence of aura increased. The proportion of those with 10 to 14 headache days per month also increased, from 12.5% in those ages 18 to 29 to 41.0% (odds ratio = 4.8, 95% CI = 3.9 to 7.1) in those older than 70. CONCLUSION: The profile of migraine changes over the life span and suggests three nonexclusive profiles. In many, migraine remits. In some patients with migraine, attacks get less typical, resembling probable migraine instead of full migraine. In some, migraine progresses.
Adolescent↗
Migraine and cardiovascular disease.
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Cardiovascular Diseases↗
Emerging drugs for migraine prophylaxis and treatment.
Migraine is a chronic neurologic disorder with heterogeneous characteristics resulting in a range of symptom profiles, burden, and disability. Migraine affects nearly 12% of the adult population in occidental countries, imposing considerable economic and social losses. The pharmacologic treatment of migraine includes preventive and acute strategies. A better understanding of the migraine pathophysiology along with the discovery of novel molecular targets has lead to a growing number of upcoming therapeutic proposals. This review focuses on new and emerging agents for the treatment of migraine.
Fructose↗
Chronic disorders with episodic manifestations: focus on epilepsy and migraine.
Epilepsy and migraine are chronic neurological disorders with episodic manifestations that are commonly treated in neurological practice and frequently occur together. In this review we examine similarities and contrasts between these disorders, with focus on epidemiology and classification, temporal coincidence, triggers, and mechanistically based therapeutic overlap. This investigation draws attention to unique aspects of both epilepsy and migraine, while identifying areas of crossover in which each specialty could benefit from the experience of the other.
Chronic Disease↗
The preventive treatment of migraine.
BACKGROUND: Migraine is a common, chronic, and disabling disorder. The treatment of migraine includes a combination of nonpharmacologic and pharmacologic techniques. Pharmacologic approaches are subdivided in preventive therapies and acute care. REVIEW SUMMARY: In this review article, we review the current approaches to the preventive treatment of migraine. Preventive treatment should be initiated in those with frequent or disabling headaches. The goals include (1) reducing attack frequency, intensity, and duration; (2) minimizing headache-related disability; (3) improving health-related quality of life; (4) avoiding headache escalation and medication misuse. In this article, we also discuss the principles of migraine prevention, as well as drugs available for this goal. We divide preventive medications on those of common use, nutraceutical compounds, and medications less frequently used. We close by briefly discussing some in-development potential preventive drugs. CONCLUSION: Preventive therapies are well suitable for migraineurs with attack-related disability despite appropriate acute care.
Adrenergic beta-Antagonists↗
Target doses and titration schedules for migraine preventive medications.
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Adult↗
Migraine in the elderly: a comparison with migraine in young adults.
OBJECTIVE: In this study we compare the clinical features of migraine attacks occurring in the elderly (60 to 70 years) and in younger migraineurs (20 to 40 years). BACKGROUND: Studies comparing the clinical features of migraine at different ages are still lacking. These studies are important for a better comprehension of the natural history of migraine, as well as to refine our recognition of the disease. METHODS: We retrospectively assessed subjects seen from 1995 to 2000 in a university-based outpatient headache clinic in Brazil. We reviewed 144 charts from patients 60 to 70 years (mean = 66.4). We applied a questionnaire based on the first edition of the International Classification of Headache Disorders (criteria for episodic migraine remained unchanged in the second edition). Controls were migraineurs from 20 to 40 years (mean = 32.6). RESULTS: Migraine occurred in 25% of the elderly and 29% of younger migraineurs (NS). A lower proportion of migraine attacks in the elderly were unilateral (38% vs. 57%, P < .01), or with associated symptoms (nausea = 75% vs. 86%, P = .05; vomiting = 30% vs. 54%, P < .05, photophobia and phonophobia = 83% vs. 94%, P < .05). Other symptoms such as paleness (P = .0441), dry mouth (P = .0093), and anorexia (P = .05) were more common in the elderly. CONCLUSION: Migraine is less typical in the elderly and more frequently associated with vegetative symptoms. Therefore, the diagnosis of migraine in elderly subjects may be more challenging, and many seniors with this primary headache can be misdiagnosed.
Adult↗
Migraine triggered by sucralose--a case report.
Sucralose is the active compound of the most commonly sold sweetener in the United States. Different than aspartame, sucralose is not considered to be a migraine trigger. Herein we report a patient with attacks of migraine consistently triggered by sucralose. She also suffers from menstrually related migraine that had been well-controlled for several months since she switched her contraceptive from fixed estrogen to triphasic contraceptive pills. Some attacks triggered by sucralose were preceded by aura, and she had never experienced migraine with aura before. Withdrawal of the compound was associated with complete resolution of the attacks. Single-blind exposure (vs. sugar) triggered the attacks, after an attack-free period.
Adult↗
Side-locked headache as the chief complaint of inflammatory orbital pseudotumor (myositic form): a case report.
The case of a 38-year-old woman with continuous unilateral side-locked headache is reported. She had continuous right-sided periorbital pain of mild to moderate intensity for the past 5 months. She also reported a few episodes of pain exacerbations every day. She had no autonomic features. Based on a normal CT scan ordered by her general physician, we started indomethacin (150 mg/day) as well as celecoxib (400 mg/day) for 2 weeks, without relief. Oral prednisone for 6 days provided important relief, and she stayed on daily use of steroids, refusing other forms of therapy. After 5 months she developed orbital and eyelid edema, with painful restrictions to eye movement. Orbital MRI and pathological exam demonstrated inflammatory orbital pseudotumor (myositic form).
Adult↗
Medications associated with probable medication overuse headache reported in a tertiary care headache center over a 15-year period.
OBJECTIVES: To evaluate the substances associated with medication overuse headache (MOH) in a headache center, over the course of the past 15 years. BACKGROUND: The acute treatment of migraine has substantially changed over the past 15 years, and therefore, the substances associated with MOH may have changed as well. METHODS: We randomly reviewed charts of subjects seen during the years of 2005, 2000, 1995, and 1990, to identify substances associated with MOH. Since the criteria proposed by the second edition of the International Classification of Headache Disorders require causal attribution, demonstrated by improvement after withdrawal (and this was not assessed in this study), herein we refer to probable MOH (PMOH). We contrasted the substances associated with PMOH over the studied years. RESULTS: Our sample consists of 1200 individuals, 300 per year of interest. The proportions of subjects with a diagnosis of PMOH remained stable over the years, varying from 64% of all cases seen in the center in 1990, to 59.3% in 2005. We found a significant decrease in the relative frequency of probable ergotamine overuse headache (from 18.6% to 0%, P < .0001), and in probable combination analgesic overuse headache (from 42.2% to 13.6%, P < .0001). The differences were not significant for opioid overuse headache. The relative frequency increased significantly for the triptans (from 0% to 21.6%, P < .0001), simple analgesics (from 8.8% to 31.8%, P < .05), and for combinations of acute medications (from 9.8% to 22.7%, P = .01). CONCLUSION: While overuse of acute medications remains an important problem in the tertiary care arena, the substances associated with the overuse have dramatically changed over the past 15 years. Educational initiatives should emphasize that the newer specific acute migraine medications (triptans) may also be associated with PMOH.
Adult↗
Modifiable risk factors for migraine progression (or for chronic daily headaches)--clinical lessons.
Herein we summarize clinical issues gleaned from a full peer-reviewed article on modifiable risk factors for migraine. Since migraine is progressive in some but not in most individuals, identifying patients at risk for progression is crucial. Key interventions include: (1) Decrease headache frequency with behavioral and pharmacologic interventions; (2) Monitor the body mass index and encourage maintenance of normal weight; (3) Avoid medication overuse; (4) Avoid caffeine overuse; (5) Investigate and treat sleep problems and snoring; (6) Screen and treat depression and other psychiatric comorbidities. These recommendations have not been demonstrated to improve outcomes in longitudinal studies.
Disease Progression↗
Modifiable risk factors for migraine progression.
Migraine is a chronic-recurrent disorder that progresses in some individuals. Transformed migraine is the result of this progression. Since migraine does not progress in most patients, identifying the risk factors for progression has emerged as a very important public health priority. If risk factors can be identified, that might provide a foundation for more aggressive preventive intervention. Risk factors for progression may be divided into non-remediable (gender, age, race) and remediable categories. In this paper, we focus on several already identified remediable risk factors, including frequency of migraine attacks, obesity, acute medication overuse, caffeine overuse, stressful life events, depression, and sleep disorders. We present the evidence for each risk factor and discuss possible interventions to address them.
Anxiety Disorders↗
Subcortical lesions in migraine: are they related to mitochondrial dysfunction?
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Brain↗
When migraine progresses: transformed or chronic migraine.
Migraine may be conceptualized, not just as an episodic disorder, but as a chronic recurrent and sometimes chronic progressive disorder. Transformed migraine, often referred to as chronic migraine is the result of migraine progression. This article will review the clinical features of transformed migraine, highlighting that its phenotype varies according to stage. Early in the process of transformation, attacks with migraine features are very common. As the disease evolves, most attacks lack the migraine features. The risk factors for migraine progression and the mechanisms for progression will be discussed. This review concludes with the prospects for treating transformed migraine and avoiding migraine progression.
Analgesics↗
Role of melatonin in the pathophysiology of migraine: implications for treatment.
The pineal gland and its secretory product, melatonin, have been implicated in the pathophysiology of migraine, as well as some of its comorbid disorders. Supporting this view, many migraineurs are susceptible to various environmental triggers that influence the secretion of melatonin from the pineal gland, and many prodromal symptoms are probably generated in the hypothalamus, a brain region that provides input into the pineal gland to modulate the secretion of melatonin. In addition, studies have shown abnormalities in melatonin secretion in patients who experience migraine and an improvement in migraine following administration of melatonin. However, the dysfunction in melatonin secretion in migraineurs may simply be a marker of hypothalamic dysfunction or neuronal hyperexcitability, leading to migraine susceptibility. It is also possible that abnormal melatonin secretion leads to decreased inhibitory neurotransmitter activity, decreased inhibition of the release of calcitonin gene-related peptide (CGRP) from activation of the trigeminal system, or less analgesia. Whatever its role in the pathogenesis of migraine, melatonin may prove to be a useful therapy. Future studies are necessary to further elucidate whether melatonin is a well tolerated, beneficial therapy, and to determine the optimal dose and formulation of melatonin for use in migraine therapy.
Animals↗
Obesity and migraine: a population study.
OBJECTIVE: To assess the influence of body mass index (BMI) on the prevalence, attack frequency, and clinical features of migraine. METHODS: In a population-based telephone interview study, the authors gathered information on headache, height, and weight. The 30,215 participants were divided into five categories, based on BMI: 1, underweight (< 18.5), normal weight (18.5 to 24.9), overweight (25 to 29.9), obese (30 to 24.9), and morbidly obese (> or = 35). Migraine prevalence and modeled headache features were assessed as a function of BMI, adjusting by covariates (age, sex, marital status, income, medical treatment, depression). RESULTS: Subjects were predominantly female (65% female) and in middle life (mean age 38.4). BMI group was not associated with the prevalence of migraine, but was associated with the frequency of headache attacks. In the normal weight group, 4.4% had 10 to 15 headache days per month, increasing to 5.8% of the overweight (odds ratio [OR] = 1.3), 13.6% of the obese (OR = 2.9), and 20.7% of the morbidly obese (OR = 5.7). The proportion of subjects with severe headache pain increased with BMI, doubling in the morbidly obese relative to the normally weighted (OR = 1.9). Similar significant associations were demonstrated with BMI category for disability, photophobia, and phonophobia. CONCLUSION: Though migraine prevalence is not associated with body mass index, attack frequency, severity, and clinical features of migraine increase with body mass index group.
Adolescent↗