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PubMed2000

Angiotensin-converting enzyme gene deletion polymorphism determines an increase in frequency of migraine attacks in patients suffering from migraine without aura.

Many authors have reported an association between the angiotensin-converting enzyme (ACE)-D allele and coronary heart disease and other cardiovascular diseases. The mechanism underlying the positive associations between the ACE-D alleles and diseases are not yet clear. Previous reports showed an association between migraine without aura and ACE-D allele polymorphism. The study is aimed to evaluate if the DD genotype could also be associated with the frequency and duration of migraine without aura. In 302 patients suffering from migraine without aura (at least for 1 year), with no history of cardiovascular diseases and major risk factors for ischemic events, the genotypes of the ACE gene, plasma ACE activity, and the frequency (weekly) and duration of migraine attacks were evaluated. No drugs were given before (4 weeks) and during the study. The same evaluations were performed in 201 subjects without migraine. The molecular biologist and the physician evaluating the patient data were blinded to the clinical history and ACE-DD gene determination. Genotypes were determined by polymerase chain reaction amplification. Plasma ACE activity was performed by the HPLC method. The groups were similar for sex, age and smoking habit (migraines: 302 patients (200 F/102 M), mean age 37.8 +/- 8.2 years; control: 201 subjects (127 F/74 M), mean age 37.5 +/- 9.3 years). Patients with migraine without aura showed higher incidence of the ACE-DD gene (48.34%) than control subjects (37.32%), p < 0.05. The frequency of migraine (average attacks per week) was higher in patients with DD (2.11 +/- 1.9) than in patients with ID (1.54 +/- 1. 44), p < 0.05. No difference in duration of migraine attacks (hours per week) was observed. Plasma ACE activity was increased in patients with the ACE-DD gene. Our data suggest that ACE-DD gene polymorphism could have an important role in determining migraine attacks and the frequency of these attacks. Further data are needed through further studies, especially on the biomolecular level.

Adult↗
PubMed2003

Evidence for a separate type of migraine with aura: sporadic hemiplegic migraine.

OBJECTIVE: To compare clinical characteristics of patients with sporadic hemiplegic migraine (SHM) with those of patients with migraine with typical aura (MA) and patients with familial hemiplegic migraine (FHM). METHODS: The authors used a computer search of Denmark's National Patient Register to screen the population for patients with migraine with aura with motor weakness, and also examined case records from headache clinics and private practicing neurologists and placed advertisements. The authors screened patients and their relatives with a semi-structured validated telephone interview. All recruited patients were then interviewed by a physician and given a neurologic examination. RESULTS: A total of 105 patients with SHM were identified. Seventy-two percent had four typical aura symptoms: visual, sensory, aphasic, and motor. All had at least two symptoms present during SHM attacks. A gradual progression and sequential appearance of aura symptoms was typical; compared with MA, the duration of each aura symptom was usually prolonged and bilateral motor symptoms were more frequent. Of the patients with SHM, 72% fulfilled the criteria for basilar migraine during SHM attacks. The aura was usually followed by headache, as is common in FHM but not MA. CONCLUSIONS: Patients with sporadic hemiplegic migraine had clinical symptoms identical to familial hemiplegic migraine and significantly different from migraine with typical aura. Sporadic hemiplegic migraine is a separate entity, and should be classified with familial hemiplegic migraine.

Adolescent↗
PubMed2005

Chronic migraine is an earlier stage of transformed migraine in adults.

BACKGROUND: Chronic migraine (CM) is characterized by 15 or more migraine days per month. Most adults with chronic daily headache (CDH) that evolved from migraine have < 15 days of migraine/month. They are often classified as transformed migraine (TM), a disorder not addressed in the International Headache Society classification. OBJECTIVE: To test the hypothesis that early in the course of migraine chronification, the frequency of migraine attacks is high and that as illness progresses the frequency of nonmigraine headaches increases. METHODS: Information was collected on 402 adults with TM and was divided into two groups. Group 1 TM had > or = 15 days of migraine/month, whereas Group 2 TM had < 15 days of migraine/month. Risk factors were modeled for number of migraine days per month using logistic regression. RESULTS: Of 402 subjects with TM, 121 (30.1%) were in Group 1. The proportion of Group 1 subjects decreased with age, from 71% below age 30 to 22% age 60 or above. The correspondent proportion of Group 2 increased from 29 to 78%. More than 15 days of migraine per month was independently predicted by younger ages (< 40 years; p = 0.002), shorter interval from episodic to CDH (< 5 years; p = 0.003), and shorter time since the development of CDH (< 6 years; p < 0.0001). CONCLUSION: Chronic migraine is an earlier stage of transformed migraine.

Adolescent↗
PubMed2006

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↗
PubMed1996

Non-migrainous headache, neck or shoulder pain, and migraine--differences in association with background factors in a city population.

OBJECTIVE: To study the pattern of association of background factors with reported migraine, non-migrainous headache, and neck or shoulder pain. DESIGN: In a cross-sectional survey the population of the municipality of Tromsø between 20 and 56 years of age was screened for risk factors of different diseases. Everybody attending the screening was given a questionnaire on psychosocial, lifestyle, and health factors. The odds ratios of reporting migraine, non-migrainous headache, and neck or shoulder pain were estimated by logistic regression for several background factors. SETTING: A population-based study conducted in the municipality of Tromsø, northern Norway. PARTICIPANTS: In a survey of risk factors for diseases in 1987/86, all the subjects between 20 and 56 years of age in the municipality of Tromsø were invited. The attenders were given a questionnaire about lifestyle, health, and psychosocial factors. Of the 18105 people who were given a questionnaire, 8537 men and 9162 women (97.7%) answered the questions about "non-migrainous headache", 8533 men and 9117 women (97.5%) answered the questions about neck or shoulder pain, and 8024 men and 7690 women (86.8%) the questions about migraine. MAIN RESULTS: "Self estimated health" had the strongest association with all three target conditions although the strength of the association between headache and neck or shoulder pain was far higher than that of migraine. The reporting of headache and neck or shoulder pain was associated with psychosocial factors, in contrast to migraine. The less educated women were prone to both headache and neck or shoulder pain, while there was no association between migraine and length of education. The explored lifestyle factors were not associated with any of the target conditions. CONCLUSIONS: Our findings underscore that migraine is reported by people with psychosocial backgrounds other than those of people who report chronic headache and neck or shoulder pain.

Acute Disease↗
PubMed1980

[Cerebral ischemic accidents during migraine attacks. A report on "complicated migraine"].

The authors use the term "complicated migraine" to describe the onset of neurological disorder occurring during an acute attack in a patient with chronic migraine. The disturbance may last for long periods or may be permanent, and these irreversible cerebral lesions have to be differentiated from the transient neurological effects characteristic of ophthalmic on secondary migraine. Patients with migraine and retinal lesions, as well as those with ophthalmoplegic or familial hemiplegic migraine, were excluded from the study. The seven cases reported included 5 women and 2 men with an average age of 30 years (from 14 to 51 years). A more or less severe lesion in a hemisphere was present, which led to sensory-motor signs of a hemiplegia (4 cases), an aphasia (4 cases), and a homonymous lateral hemianopia (3 cases). Exploration revealed the presence of an ischemic cerebral lesion in all cases. One or more arterial occlusions were also noted in 5 out of the 6 patients who were investigated by angiography. All cases showed the presence of the criteria thought to be essential for associating the cerebral ischemic lesion with migraine. 1) the patient had true migraine, 2) there was a close chronological relationship between the migraine attack and the lasting neurological disorder, 3) no other associated vascular disease was present (atheroma, cardiopathy). The very severe and prolonged spasm, which could be the cause of neurological disturbances in secondary and ophthalmic migraine, does not appear to be sufficient for producing an irreversible ischemic lesion and, more especially, a persistent vascular obstruction. The roles played by edema of the arterial wall and parietal changes in the vessels are discussed. It could be that thrombosis formation is encouraged by the changes in blood coagulability which may be associated with a migraine attack. The fact that anomalies in platelet aggregation have been demonstrated merits closer study.

Adolescent↗
PubMed2003

A self-administered screener for migraine in primary care: The ID Migraine validation study.

BACKGROUND: Migraine is a highly prevalent and disabling illness that remains substantially undiagnosed in primary care. Because of the potential value of a screening tool, the current study was designed to establish the validity and reliability of a brief, self-administered migraine screener in patients with headache complaints in the primary care setting. METHODS: A total of 563 patients presenting for routine primary care appointments and reporting headaches in the past 3 months completed a self-administered migraine screener. All patients were then referred for an independent diagnostic evaluation by a headache expert, of whom 451 (80%) completed a full evaluation. Migraine diagnosis was assigned based on International Headache Society criteria after completing a semi-structured diagnostic interview. RESULTS: Of nine diagnostic screening questions, a three-item subset of disability, nausea, and sensitivity to light provided optimum performance, with a sensitivity of 0.81 (95% CI, 0.77 to 0.85), a specificity of 0.75 (95% CI, 0.64 to 0.84), and positive predictive value of 0.93 (95% CI, 89.9 to 95.8). Test-retest reliability was good, with a kappa of 0.68 (95% CI, 0.54 to 0.82). The sensitivity and specificity of the three-item migraine screener was similar regardless of sex, age, presence of other comorbid headaches, or previous diagnostic status. CONCLUSIONS: The three-item ID Migraine migraine screener was found to be a valid and reliable screening instrument for migraine headaches. Its ease of use and operating characteristics suggest that it could significantly improve migraine recognition in primary care.

Adolescent↗
PubMed1994

EEG features in juvenile migraine: topographic analysis of spontaneous and visual evoked brain electrical activity: a comparison with adult migraine.

Topographic analysis of spontaneous and steady-state visual evoked brain electrical activity was carried out between attacks in 82 migraine patients (40 youths and 42 adults). In adult migraine with aura a significant increase of delta rhythm percentage power was observed compared with migraine without aura and age-matched controls. Children suffering from migraine both with aura and without aura had an increased theta rhythm compared to normal controls. The presence of alpha interhemispheric asymmetry discriminated between migraine with aura and without aura, just as in adults. An increased amplitude of the SVEP F1 component with a tendency to the spread of visual reactivity was observed in juvenile migraine with and without aura; this pattern was not dissimilar from the one previously observed in adult migraine with and without aura. Abnormal photic driving in migraine is independent of age and type of migraine.

Adolescent↗
PubMed1994

Exteroceptive suppression of temporalis muscle activity during migraine attack and migraine interval before and after treatment with sumatriptan.

We compared the early (ES1) and late (ES2) exteroceptive suppression (ES) periods of temporalis muscle activity in 18 migraine patients during both the migraine interval and migraine attack and investigated the effect of sumatriptan and placebo on ES parameters. The measurements were performed in a balanced sequence at four different times on each patient, twice during the migraine interval and once in each of two migraine attacks. First ES1 and ES2 were measured (stimulus intensity 20 mA, stimulus duration 0.2 ms, stimulation frequency 2 Hz, averaging of 10 responses), then the medication was given on a double-blind basis with an autoinjector using either 6 mg sumatriptan or a placebo solution. Thirty minutes after application the measurements were repeated. No significant differences were found in early and late exteroceptive suppression latencies and durations between baseline measurements. Treatment did not affect the latencies of ES1 and ES2. While sumatriptan caused a significant increase in ES1 duration (p < or = 0.05) both during the migraine interval and during the migraine attack, placebo showed no significant effect on ES1 duration. Treatment with sumatriptan during the migraine attack was accompanied by a significant increase in the duration of ES2 (p < or = 0.05), but no significant changes in the durations of the late suppression periods were observed under any other conditions. The results do not support the assumption that under the experimental conditions chosen migraine attacks are accompanied by a paroxysmal change in the brain-stem mechanisms involved in the modulation of the ES parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Validation of a migraine work and productivity loss questionnaire for use in migraine studies.

Migraine symptoms and therapy side effects cause significant functional disability that can result in work and productivity losses. Effective, well-tolerated migraine therapy with rapid onset of relief could decrease work and productivity losses. The Migraine Work and Productivity Loss Questionnaire (MWPLQ) evaluates the impact of migraine and migraine therapy on paid work. Data from a randomized, open-label extension study were collected over 3 months. Migraineurs were randomized to either rizatriptan (5HT1B/1D receptor agonist) or their usual migraine therapy. Data were analyzed from 164 patients who experienced at least one work-related migraine. Internal consistency (Cronbach's alpha) for the work difficulty domains ranged from 0.80 to 0.95. Work loss and work difficulty were moderately correlated (r = 0.39-0.58) with migraine severity and functional ability. Differences were found favoring rizatriptan for absenteeism (1.3 vs 2.4 h), effectiveness at work (62% vs 49%), and difficulty with work-related tasks (p < 0.01). The MWPLQ demonstrated favorable measurement characteristics in this study and could be an important research tool for future evaluations of migraine-related work disability.

Absenteeism↗
PubMed2000

Daily migraine with aura: a new migraine variant.

The frequency of migraine attacks is not used as a diagnostic criterion, however, it is a very important factor in the evaluation of migraine severity and its treatment. Several studies report the frequency of migraine attacks using the International Headache Society criteria. No investigator, however, has reported daily migraine attacks. In the current report, we present five patients whose headaches transformed from episodic migraine to daily migraine with aura. To the best of our knowledge, this is the first description of this variant of migraine. The symptoms in all the patients described comply strictly with the International Headache Society criteria for the diagnosis of migraine with typical aura. An interesting additional observation concerns the beneficial effect of phenytoin, a drug that has not proved to be effective in migraine but showed some efficacy in our patients.

Aged↗
PubMedDate not supplied

Migraine changes with age: IMPACT on migraine classification.

OBJECTIVE: To establish if criteria for the diagnosis of migraine change with age and to document the influence of age on the full spectrum of migraine features. Also to define the clinical spectrum and provide a prognostic profile of migraine stratified by age. BACKGROUND: Few studies have formally analyzed migraine characteristics stratified by age in a large cohort of patients. METHODS: One thousand nine consecutive patients meeting ICHD-2, 1.1, 1.2, and 1.5.1 at their initial office visit were studied. Patients were stratified by age into 3 groups: group I, 16 to 29, group II, 30 to 49, and group III, 50 years or older. Variables studied included gender, headache duration in years, prodrome, aura, postdrome, headache triggers, headache characteristics, associated symptoms, headache location, headache frequency, headache days, and disability. Ordinal variables were graded from 0 to 3 but only grades greater than grade 1 (more than occasional) were used in the study. RESULTS: A total of 86.3% patients were female and mean age was 37.7 years +/- 11.7 years (range 16 to 80), headache duration 15.0 years, and headache frequency 10 headaches per month. STUDY RESULTS: No significant age differences were seen in gender, or frequency of prodrome, aura, or postdrome. In patients with aura the percentage of headaches with aura significantly decreased with age. Headache triggers, in general, showed no age differences; specific triggers showed statistical differences: stress as a trigger decreased with age; alcohol, smoke, and neck pain triggers increased with age, while in women hormones as a trigger peaked markedly in the 30- to 49-year-old age group compared with the other ages. Exercise, food, not eating, heat, lights, perfume, sex, sleep disturbance, sleeping late, and weather triggers showed no significant differences in age. Headache location showed no differences except for neck location, which significantly increased with age. Associated symptoms of photophobia, phonophobia, dizziness decreased with age and running of the nose/tearing of the eyes increased with age. Nausea, vomiting, osmophobia, taste abnormalities, and diarrhea showed no significant differences. Headache quality showed decreasing throbbing, pressure, and stabbing with age, but aching showed no statistical difference. Being forced to sleep or rest with headache showed a significant decrease with age, but no significant differences were seen in other acute migraine characteristics, including choose to sleep or rest with headache, function during headache, average intensity and duration of headache, recurrence rate of headache, headache aggravation by activity, response to acute medication, and acute medication satisfaction. The 50+ age group tended to have less dizziness, photophobia, phonophobia, nausea, vomiting, temporal location, throbbing, pressure, stabbing, headache days, moderate days, severe days, aggravation of headache by activity, and recurrence but tended to have more mild days, greater ability to function during headache, and greatest response to acute medication. Despite no difference from other groups in headache intensity and duration of headache, these findings taken together seem to reflect a "lesser migraine" in the 50+ age group. CONCLUSIONS: This study highlights specific age differences in migraineurs, in most instances showing an age decline in frequency of variables, such as stress as a trigger, photophobia, phonophobia, dizziness, throbbing, pressure, stabbing, and being forced to sleep or rest with headache. Hormones as a trigger peaked in women in the 30- to 49-year-old age group. Increases with age were seen with alcohol, smoke, and neck pain triggers, neck location, and running of the nose/tearing of the eyes. The 50+ age group showed trends suggesting a "lesser acute migraine attack." These findings support the concept of lessening features of migraine over time resulting in a lower prevalence of migraine in older patients.

Adolescent↗
PubMed2000

[Physiopathology of the migraine attack and mechanisms of action of anti-migraine agents: recent findings in animals].

No current experimental model on migraine is fully satisfactory, and constructing a single model which takes into account all the various clinical and pharmacological aspects does not seem feasible. A critical review of the large number of experimental approaches developed over the past 20 years to investigate migraine attacks and an examination of recent research in the various fields of animal biology seems to be more pertinent in this context. A neurovascular cortical spreading depression could be one of the mechanisms involved in aura formation, but its association with headache is enigmatic, and the implication of hypoxia in its etiopathogenesis remains controversial. Intercritical neuronal hyperexcitability, which has been proposed as a possible biological basis for the onset of migraine, may trigger the development of aura, but also the activation of the trigeminovascular system. An independent but concomitant activation of both phenomena could be driven by a mesencephalic noradrenergic or cortical limbic generator. The trigemino-vascular model of perivascular neurogenic inflammation does not explain certain experimental and pharmacological properties of anti-migraine drugs. The clinical efficacy of the 5-HT1B/D agonists is based on a vasoconstrictive effect and on their inhibition of neurogenic inflammation, while calcitonin gene-related peptide (CGRP) plays a major role in vasodilatation and substance P in neurogenic inflammation. The initiation and initial development of migraine probably involve a prior peripheral sensitization of the trigeminal nociceptors, while the susceptibility to onset of an attack, maintenance of the migrainous state and the clinical variability must certainly rely on central sensitization within the trigeminal caudate nucleus. The numerous experimental approaches to the physiopathology of migraine developed over recent years, each of which provides a basis for the development of new classes of anti-migraine drugs, are not exclusive of one another. Rather, they contribute to providing various specific aspects of a physiopathogenic theory of migraine, which at the present time has to be both wide-ranging and adaptive.

Animals↗
PubMedDate not supplied

Laterality of pain and other migraine criteria in common migraine. A comparison with cervicogenic headache.

Patients diagnosed as suffering from common migraine according to the "Ad hoc committee" criteria of 1962 have been studied as for type of unilaterality of headache. Patients, with trauma to the face, head, and neck were excluded, together with patients with the faintest suspicion of aura and those with chronification of the headache. Common migraine criteria, as stipulated by the IHS and Vahlquist, were counted in every patient (n = 32), except the laterality which was a free variable (a total of 8 variables remaining). For comparison, as far as the number of migraine criteria is concerned, a group of cervicogenic headache patients was also studied (n = 30). Unilaterality with side shift of pain was present in 75% in the common migraine group; in 34% of the patients, a combined pattern, i.e. bilateral headache + unilaterality with sideshift was present. Common migraine, therefore, just as classic migraine, seems to be a headache characterized by unilaterality with side alternation of pain. Common migraine criteria were present to a high degree in common migraine patients selected in this way, i.e. ca. 6.8 of a maximum of 7. In cervicogenic headache, the corresponding figure was ca. 3.8 (of a maximum of 7). These figures are statistically significantly different (p < 1.3 10(-11), Mann-Whitney test). Still, the level of criteria is relatively high in cervicogenic headache, and 6 of 30 patients would fulfil the IHS common migraine criteria.

Adult↗
PubMedDate not supplied

[Migraine crisis and neurological focal signs of slow or absent resolution (complicated migraine)].

Sixteen cases of vascular headache of the migraine type are referred in whom marked neurological manifestations occurred in a unilateral distribution as part of a migraine attack ("complicated migraine"). The neurologic disorders observed, in order of frequency, include 10 cases of motor hemiparesis, 3 cases of unilateral cerebellar syndrome, 1 case of sensory-motor hemiparesis and 1 case showing signs of the involvement of the motor nuclei of the bulb. The recovery of the motor, sensory, cerebellar and brainstem defects was very slow (average duration: 44.25 days; mode: 14 days) in twelve cases. Two patients showed residual neurological signs respectively after 1 and 7 years from the migraine attack. The patients histories indicate classic or common migraine with a relatively high frequency (80% of the patients experienced one or more crises per month). The most of cases (75%) were female patients. The patients, at time of the attack of complicated migraine, had a mean age years of 32. In ten cases first-grade relatives suffered from classic or common migraine; in no case was there any report of associated or complicated migraine among the relatives. In 4 of the 16 cases the CT scan showed an area of hypodensity consistent to the region of the brain expected to be suffering in view of the clinical type of neurological defect. The Authors take into consideration the controversial relation between complicated migraine with slow or incomplete resolution of neurologic signs and focal brain ischemia due to atherothrombotic infarct, pointing out that the present state of knowledge prevents the reaching of final conclusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗