Migraine headaches: a historical prospective, a glimpse into the future, and migraine epidemiology

Interaction between diabetes and body mass index on severe headache or migraine in adults: a cross-sectional study

BACKGROUND

Research on the effects of body mass index (BMI) on severe headache or migraine is limited and controversial. The aim of this study was to explore the association between BMI and the prevalence of migraine, with particular interest in diabetes status difference.

METHODS

The present study used analyzed data from people who participated in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2004. Logistic regression models and restricted cubic spline (RCS) models were applied to investigate the relationship between body mass index and migraine.

RESULTS

A total of 10,074 adults aged 20 years or older were included in this study. Body mass index was positively related to migraine, and the corresponding odds ratio (OR; 95% CI) was 1.02 (1.01, 1.03; p < 0.001). And compared to participants in the lowest group of body mass index (< 25 kg/m2), the adjusted ORs for migraine in medium group (25-29.9 kg/m2), and highest group (≥ 30 kg/m2) were 1.14 (95% CI: 0.98-1.32, p = 0.09) and 1.30 (95% CI: 1.11-1.52, p = 0.0022), respectively. The relationship between BMI and migraine exhibited a linear in overall in the RCS. Our findings also suggested an interaction between BMI and diabetes. The relationship between BMI and migraine in adults with diabetes was non-linear. The OR of developing migraine was 1.30 (95% CI: 1.10-1.54) in individuals with BMI ≥ 29.71 kg/m2 in adults with diabetes.

CONCLUSION

A higher body mass index is significantly associated with an increased prevalence of migraine, and diabetes status can modify the association between them.

Migraine in Assiut Governorate, Egypt: epidemiology, risk factors, comorbid conditions and predictors of change from episodic to chronic migraine

OBJECTIVES

Headache is one of the most common complaints in medicine. Epidemiological and population-based studies reported that migraine has a variable prevalence worldwide. This study was done to estimate the prevalence of migraine across various age groups in Assiut district, Egypt.

METHODS

This is a door-to-door study. It included 4700 randomly selected individuals.

RESULTS

Headache was reported in 1668 subjects (35.49%), of them, 87.65% (n = 1462) had primary headaches. Migraine prevalence was 10.51% with female-to-male ratio of 2.4:1 particularly in ages of 20-40 years. The mean age of patients was 31.46 ± 13.39 years and age at onset was 24.16 ± 12.10 years. Nearly, 63.5% had frequent attacks, 65.2% of the attacks were severe enough to stop daily activities and lasted for >1 day in 32.5% of females compared to 40.7% and 14.5% for males. Chronic or daily migraine was more in females (35.3% versus 20.7% for males). Approximately, 5.6% had chronic migraine and 1.2% had daily migraine from the start, while 24.2% had transformation from episodic to chronic migraine within 6.1 ± 4.4 years. Migraine was prevalent among those with middle educational levels and labor workers. The duration of migraine attacks was found to reduce with age but the chronic/daily migraine increased with age. Hypertension, anxiety, irritable bowel syndrome, and depression were common comorbidities with migraine.

CONCLUSIONS

We believe that the work done in this study is informative as it determined the actual prevalence of migraine across various age groups and the important predictors of change in the severity, duration, and frequency of migraine in our locality.

Validation of the peripheral trigger point theory of migraine headaches: single-surgeon experience using botulinum toxin and surgical decompression

BACKGROUND

Migraine headache is a widespread neurovascular disorder that is often suboptimally or incompletely treated. This article confirms the efficacy of botulinum toxin treatment with surgical decompression as a deactivator of migraine headache trigger sites through the retrospective analysis of a single surgeon's experience.

METHODS

A retrospective chart review was performed on 24 patients presenting with the diagnosis of migraine headache. Botulinum toxin type A injections were used to identify frontal, temporal, and/or occipital trigger points. The nasal trigger point was diagnosed with a decongestant trial, intranasal examination, and computed tomographic scan. Those patients with more than one trigger point underwent multiple surgical procedures, which were performed concomitantly during the same operation. All botulinum toxin injections, surgical procedures, and patient meetings were conducted by the principal investigator (J.E.J.), minimizing intrapatient treatment variability and multiprovider bias.

RESULTS

Patient progress was tracked by consolidating migraine frequency, severity, and duration as a Migraine Headache Index. Nineteen patients (79.2 percent) benefited from surgery. Two patients (8.3 percent) reported migraine elimination and 17 patients (70.8 percent) reported significant improvement of their migraine symptoms. Among those patients who responded to surgery, average improvement from baseline levels was 96.9 percent. Among the entire patient population, average improvement was 78.2 percent from baseline. The mean postsurgical follow-up was 661 days.

CONCLUSION

This study found botulinum toxin treatment with surgical decompression to be a potent deactivator of migraine headache trigger sites, corroborating the findings of the current literature in the field and underlining the reproducibility of the treatment.

CLINICAL QUESTION/LEVEL OF EVIDENCE

: Therapeutic, IV.(Figure is included in full-text article.).

Picasso's migraine: Illusory cubist splitting or illusion?

It is widely believed that Pablo Picasso suffered from migraine. The main cause for this is our suggestion made 10 years ago that some of Picasso's paintings resemble migraine auras. Here we critically look back at our own hypothesis. We conclude that, although the idea is still fascinating, there is no proof of Picasso suffering from migraine with aura.

Tonabersat, a gap-junction modulator: efficacy and safety in two randomized, placebo-controlled, dose-ranging studies of acute migraine

Tonabersat is a novel benzopyran derivative that blocks the cortical spreading depression proposed to be associated with migraine attacks. The ability of single oral doses of 15, 25, 40 and 80 mg of tonabersat to relieve the symptoms of moderate to severe migraine was evaluated in 859 migraineurs enrolled in two dose-ranging, double-blind, randomized, placebo-controlled, parallel-group trials, one international and the other North American. In the international study, significantly more patients given tonabersat than given placebo experienced relief of headache pain at 2 h (15 mg, 36.8%; 40 mg, 40.7%), the principal efficacy variable, and at 4 h (40 mg, 63.0%) and complete abolition of headache at 4 h (40 mg, 34.3%). None of the primary or secondary efficacy variables indicated significant differences between tonabersat and placebo in the North American study. Tonabersat was generally well tolerated, with dizziness and nausea the most common side-effects. Serious adverse events were uncommon, and no patient withdrew from either study because of adverse events. These results suggest a possible interplay between tonabersat pharmacokinetics (the relatively long time required to reach maximum plasma concentrations) and patient characteristics (previous triptan exposure) in the management of acute migraine attacks. Based on the pharmacokinetics and actions on cortical spreading depression, tonabersat may have potential value in migraine prophylaxis.

Neurological mechanisms of migraine: potential of the gap-junction modulator tonabersat in prevention of migraine

Migraine is a neurovascular disorder characterized by recurrent episodic headaches, and is caused by abnormal processing of sensory information due to peripheral and/or central sensitization. The exact pathophysiological mechanism underlying migraine is not fully understood; however, cortical spreading depression (CSD) is thought to provide the basis for migraine aura and may serve as a trigger of migraine pain. CSD depends on neuronal-glial cell communication, which is mediated by intercellular transfer of messengers through connexin-containing gap junctions, as well as messengers released into the extracellular space by non-junctional connexin-containing hemichannels. These processes are believed to be important in peripheral sensitization within the trigeminal ganglion and to lead to central sensitization. The novel benzopyran compound tonabersat binds selectively to a unique site in the brain. In preclinical studies, tonabersat markedly reduced CSD and CSD-associated events and inhibited gap-junction communication between neurons and satellite glial cells in the trigeminal ganglion. Together, these findings suggest that tonabersat should have clinical application in preventing migraine attacks.

Body mass index and headaches: findings from a national sample of US adults

The objective was to study the cross-sectional association between body mass index (BMI) and the prevalence of severe headaches or migraines in a national sample of US adults. We used data from 7601 men and women aged > or = 20 years who participated in the National Health and Nutrition Examination Survey 1999-2002. The age-adjusted prevalence of severe headaches or migraines during the previous 3 months was 34.0, 18.9, 20.7 and 25.9% among participants with a BMI < 18.5, 18.5 to < 25, 25 to < 30 and > or = 30 kg/m(2), respectively. After adjusting for a variety of covariates in a logistic regression model, those with a BMI < 18.5 kg/m(2)[odds ratio (OR) 2.01; 95% confidence interval (CI) 1.34, 3.02] or > or = 30 kg/m(2 )(OR 1.37; 95% CI 1.09, 1.72) had a significantly elevated OR for having a headache compared with participants with a BMI of 18.5-< 25 kg/m(2). BMI is associated with the prevalence of severe headaches or migraines in a non-linear manner.

Statins decrease expression of the proinflammatory neuropeptides calcitonin gene-related peptide and substance P in sensory neurons

Clinical and experimental observations suggest that statins may be useful for treating diseases presenting with predominant neurogenic inflammation, but the mechanism(s) mediating this potential therapeutic effect are poorly understood. In this study, we tested the hypothesis that statins act directly on sensory neurons to decrease expression of proinflammatory neuropeptides that trigger neurogenic inflammation, specifically calcitonin gene-related peptide (CGRP) and substance P. Reverse transcriptase-polymerase chain reaction, radioimmunoassay, and immunocytochemistry were used to quantify CGRP and substance P expression in dorsal root ganglia (DRG) harvested from adult male rats and in primary cultures of sensory neurons derived from embryonic rat DRG. Systemic administration of statins at pharmacologically relevant doses significantly reduced CGRP and substance P levels in DRG in vivo. In cultured sensory neurons, statins blocked bone morphogenetic protein (BMP)-induced CGRP and substance P expression and decreased expression of these neuropeptides in sensory neurons pretreated with BMPs. These effects were concentration-dependent and occurred independent of effects on cell survival or axon growth. Statin inhibition of neuropeptide expression was reversed by supplementation with mevalonate and cholesterol, but not isoprenoid precursors. BMPs signal via Smad activation, and cholesterol depletion by statins inhibited Smad1 phosphorylation and nuclear translocation. These findings identify a novel action of statins involving down-regulation of proinflammatory neuropeptide expression in sensory ganglia via cholesterol depletion and decreased Smad1 activation and suggest that statins may be effective in attenuating neurogenic inflammation.