Neurophysiological and Clinical Outcomes in Episodic Migraine Without Aura: A Cross-Sectional Study

Migraine among King Khaled University students; prevalence, determinants, and impact on academic life

BACKGROUND

Migraine is a common primary headache disorder that significantly affects academic life and is often associated with stress, depression, anxiety, and irregular sleep patterns among university students. This study aimed to assess the prevalence of migraine among King Khalid University (KKU) students, identify its determinants, and evaluate the impact of migraine and other headaches on academic life and performance.

METHODS

An analytical cross-sectional study was conducted among 732 students from Colleges of Medicine, Pharmacy, Engineering, and Computer science. We used a self-administered questionnaire, including the ID Migraine™ screening tool, which was administered either through an online survey or face-to-face. Convenience and snowball sampling methods were adopted to recruit participants between June 1 and August 31, 2024.

RESULTS

The median [interquartile range (IQR)] age was 21(2.0) years, 58.2 % were female, 97.5 % were Saudi, and 93.0 % were non-smokers. The prevalence of migraine was 44.1%. The key predictors of migraine were female gender (adjusted odds ratio (AOR) = 1.78 (1.29 - 2.46), P < 0.001), family history AOR = 2.39 (1.75- 3.27), P < 0.001], working alongside education (AOR = 1.95 (1.19 - 3.18), P = 0.007), family debt (AOR = 1.86 (1.06 - 3.29), P = 0.03), and having chronic diseases like bronchial asthma (AOR = 2.16 (1.11 - 4.20), P = 0.02) and hypertension AOR = 6.23 (1.34 - 28.84), P = 0.01). Over 90 % reported migraines affected concentration, sleep, and exam preparation, and 65 % indicated an impact on university attendance.

CONCLUSIONS

Migraines are highly prevalent among KKU students, affecting academic daily life. Early detection and lifestyle changes are essential, and universities should plan and implement coping strategies to support affected students.

Tracking Migraine Symptoms: A Longitudinal Comparison of Smartphone-Based Headache Diaries and Clinical Interviews

Background/Objectives: By leveraging the capabilities of a smartphone-based headache diary, the objective of this study was to determine the amount of agreement between migraine-associated symptomatology during headache events and the symptoms documented during clinician-led intake interviews. Methods: This was a 90-day longitudinal, smartphone-based headache calendar study for participants diagnosed with migraine. Registered headache events were labeled as "definite migraine", "probable migraine", and "not migraine" in accordance with the International Classification of Headache Disorders, Third Edition (ICHD-3) criteria. Symptoms' agreement with clinician-led intake interviews (agreement percentages and kappa coefficients), symptoms' similarity between headache events within users (percentage), and amount of newly registered ICHD-3 symptoms per participant were calculated. Results: Twenty-seven participants provided 505 headache events eligible for analysis. The median agreement between recorded headache event symptomatology and clinician-led intake interview phenotyping ranged between 40% (for events fulfilling "not migraine" criteria) and 55.5% ("definite migraine") (p < 0.001). Higher intraparticipant headache event pair similarity was observed for "definite migraine" pairs (p < 0.01), along with a decreasing trend in similarity as the attack-pair headache distance increases. Over half of the participants registered at least one new ICHD-3 symptom during the study. Conclusions: Electronic diary registrations show substantial longitudinal variability in intrapersonal headache symptomatology, with the similarity of headache events declining over time. The registration of a new ICHD-3 symptom was the rule rather than the exception.

Anatomical and physiological contributions of nasal turbinate vessels and lymphatics to the pathogenesis of nasal congestion in recurrent headaches: a pilot study

Introduction

The aim of this study was to determine if specific anatomical changes were present in patients with recurrent headaches including patients with chronic migraines, chronic tension-type headaches, and daily persistent headaches. A retrospective study of 200 patients was performed to evaluate the potential of measuring the amount of nasal blood pool activity (nasal congestion) as a predictive marker for recurrent headaches.

Methods

A cohort analysis was performed involving patients who had been referred to the Nuclear Medicine Clinic over a 3-year period for whole-body blood pool scans. The scans were evaluated by region of interest (ROI) analysis of nasal and heart max pixel count ratios (NHMRs) to determine an association between nasal blood pooling activity and recurrent headaches at the time of the initial scan and in follow-up evaluations over a period of 3-6 years.

Results

Significantly greater NHMRs were observed in 122 patients with chronic headaches at the time of referral for their initial whole-body blood pool scan when compared with those patients without recurrent headaches (p = 0.004; OR 10.5; 95% CI 2.22-56.7). An additional 15 patients, for a total of 137, developed recurrent headaches following their initial scan and before their follow-up evaluation. NHMRs were also significantly increased in the additional patients when compared to those without recurrent headaches (p = 0.004; OR 12.3; 95% CI 2.34-75.5).

Conclusion

Patients with recurrent headaches have significantly increased nasal activity as observed on 99mTc-MDP whole-body blood pool scans, supporting the hypothesis that nasal lymphatic dysfunction plays a role in the etiology of recurrent headaches. This research highlights a novel diagnostic use of the whole-body blood pool scan for the assessment of nasal turbinate vasodilation as well as a possible new target for the treatment of recurrent headaches.

An Evaluation of White Matter Intensities in Patients with Pediatric Migraine

Background and Objectives: This study aims to assess white matter hyperintensities (WMHs) in pediatric migraine patients and to elucidate the pathophysiology of the disease. Materials and Methods: A total of 30 patients diagnosed with migraine and 28 healthy individuals undergoing magnetic resonance imaging (MRI) scans for various reasons in our hospital between September 2019 and April 2023 were included in the study. We evaluated the presence, number, locations, and volumetric measurement of WMHs and the relationship between hyperintensity and attack profiles in migraine patients. Results: WMHs were observed at MRI in 18 (60%) of the 30 migraine patients and in 8 (28.6%) of the 28 controls. One hyperintense lesion was detected in nine members of the patient group, two in six patients, five in one patient, eight in one patient and nine in one. One hyperintense lesion was detected in eight healthy control group members. WMHs were significantly more common in the migraine patients than in the control group (p = 0.016). There was no significant relationship between hyperintensity in migraine patients and attack duration or frequency. Analysis also revealed no significant difference in terms of hyperintensity volumes (mm3) between the study group (19.73 ± 24.26) and the control group (5.62 ± 1.83). Conclusions: This study set out to show that migraine exerts neurological effects that are not solely limited to pain by emphasizing the pronounced differences observed on the brain MRIs of migraine patients. These findings may help us achieve a better understanding of the effects of migraine on cerebral structures and functions and identify therapeutic strategies in the future.

Local Dynamic Stability of Trunk During Gait Can Detect Dynamic Imbalance in Subjects with Episodic Migraine

BACKGROUND/HYPOTHESIS

Motion sensitivity symptoms, such as dizziness or unsteadiness, are frequently reported as non-headache symptoms of migraine. Postural imbalance has been observed in subjects with vestibular migraine, chronic migraine, and aura. We aimed to assess the ability of largest Lyapunov's exponent for a short time series (sLLE), which reflects the ability to cope with internal perturbations during gait, to detect differences in local dynamic stability between individuals with migraine without aura (MO) with an episodic pattern between attacks and healthy subjects (HS).

METHODS

Trunk accelerations of 47 MO and 38 HS were recorded during gait using an inertial measurement unit. The discriminative ability of sLLE was assessed through receiver-operating characteristics curves and cutoff analysis. Partial correlation analysis was conducted between the clinical and gait variables, excluding the effects of gait speed.

RESULTS

MO showed higher sLLE values, and reduced pelvic rotation, pelvic tilt, and stride length values. sLLEML and pelvic rotation showed good ability to discriminate between MO and HS and were correlated with the perceived pain, migraine disability assessment score, and each other.

CONCLUSIONS

these findings may provide new insights into the postural balance control mechanism in subjects with MO and introduce the sLLEML as a potential measure of dynamic instability in MO.

Analysis of the center of pressure variables in women with migraine does not reflect differences in balance: A cross-sectional study

INTRODUCTION

Migraine is a neurological disease that affects proportionally more women. It has been documented that migraineurs often experience balance disturbances.

OBJECTIVE

To evaluate the balance between migraineur patients (MG) and healthy volunteers classified as control group (CG).

METHOD

A cross-sectional study. Seventy-four women were evaluated: 37 MG and 37 CG. The evaluation of the center of pressure (COP) variables was carried out using a balance platform in three postures, bipodal eyes closed (BEC), right monopodal with eyes open (RMEO), and left monopodal with eyes open (LMEO). Self-report questionnaires (dizziness handicap inventory (DHI), fall risk efficacy scale (FES I), the functional impact scale (HIT 6) and the timed up and go test (TUG test) were used. The U-Mann Whitney test was used to verify differences in the COP between MG and CG. The Kruskal-Wallis one-way ANOVA was used to analyze the differences between migraine groups (MGs) with postures, self-report questionnaires, and TUG test. A p < 0.05 was considered statistically significant.

RESULTS

No statistically significant changes were found in the balance variables, except the medial-lateral excursion variable in the BEC (p < 0.02) and LMEO (p = 0.04) postures. No significant differences were found between the MGs with HIT 6 (p = 0.48) or FES I (p = 0.49). Significant differences were found between the MGs with DHI (p = 0.003). The TUG test showed statistically significant changes between groups (p < 0.01).

CONCLUSION

The women with migraine in this sample did not show differences in postural balance, however, dizziness and functional differences are shown compared to healthy women.

Instrumental assessment of pressure pain threshold over trigeminal and extra-trigeminal area in people with episodic and chronic migraine: a cross-sectional observational study

BACKGROUND

Central and peripheral sensitization are characterized by widespread hyperalgesia that is manifested by larger pain extent area and reduction in pressure pain threshold (PPT). PPT decreases in patients with migraine not only over the trigeminal cervical complex but also throughout the body.

METHODS

A cross-sectional study was adopted to assess the local and widespread hyperalgesia in chronic and episodic migraine patients respect to healthy controls. The guidelines of Andersen's were used to evaluate the PPT bilaterally over 3 muscles in the trigemino-cervical complex (temporalis, sub-occipitalis, trapezius) and over 1 muscle far from this area (tensor fasciae latae).

RESULTS

Thirty subjects with episodic migraine (35.8 ± 2.82 years), 30 with chronic migraine (53.03 ± 19.79 years), and 30 healthy controls (29.06 ± 14.03 years) were enrolled. The interaction effect was present for the trapezius muscle with a significant difference between the right and the left side in episodic group (p = 0.003). A group effect was highlighted in all four muscles analyzed such as suboccipital (p < 0.001), temporalis (p > 0.001), trapezius (p < 0.001), and TFL (p < 0.001). PPT was usually higher in the control group than in the episodic group which in turn was characterized by higher PPT values than the chronic group.

CONCLUSIONS

People with chronic and episodic migraine presented lower PPT than healthy controls both in the trigeminal and in the extra-trigeminal area. People with chronic migraine presented lower PPT than episodic migraine only in the trigeminal area. Temporalis and sub-occipitalis are the most sensitive muscles in people with chronic and episodic migraine.

Efficacy of a dual task protocol on neurophysiological and clinical outcomes in migraine: a randomized control trial

The main aim of this study was to investigate the efficacy of a dual task protocol in people with episodic migraine with respect to both active exercises only and cognitive task only treatments, concerning some neurophysiological and clinical outcomes. A randomized control trial was adopted in people with episodic migraine without aura. Some neurophysiological and clinical outcomes were collected (t0): resting motor threshold (rMT), short intracortical inhibition (SICI) and facilitation (ICF), pressure pain threshold (PPT), trail making test (TMT), frontal assessment battery (FAB), headache-related disability (MIDAS) and headache parameters. Then, participants were randomized into three groups: active exercise only (n = 10), cognitive task only (n = 10) and dual task protocol (n = 10). After 3 months of each treatment and after 1-month follow-up the same neurophysiological and clinical outcomes were revaluated. A significant time x group effect was only found for the trapezius muscle (p = 0.012, pη2 = 0.210), suggesting that PPT increased significantly only in active exercise and dual task protocol groups. A significant time effect was found for rMT (p < 0.001, pη2 = 0.473), MIDAS (p < 0.001, pη2 = 0.426), TMT (p < 0.001, pη2 = 0.338) and FAB (p < 0.001, pη2 = 0.462). A repeated measures ANOVA for SICI at 3 ms highlighted a statistically significant time effect for the dual task group (p < 0.001, pη2 = 0.629), but not for the active exercises group (p = 0.565, pη2 = 0.061), and for the cognitive training (p = 0.357, pη2 = 0.108). The dual task protocol seems to have a more evident effect on both habituation and sensitization outcomes than the two monotherapies taken alone in people with migraine.

Effects of Anti-CGRP Monoclonal Antibodies on Neurophysiological and Clinical Outcomes: A Combined Transcranial Magnetic Stimulation and Algometer Study

BACKGROUND

the aim of this study was to investigate the neurophysiological effect of anti-CGRP monoclonal antibodies on central and peripheral levels in migraine patients.

METHODS

An observational cohort study in patients with migraine was performed. All subjects underwent Single-Pulse and Paired-Pulse Transcranial Magnetic Stimulation, as well as a Pressure Pain Threshold assessment. The same protocol was repeated three and four months after the first injection of anti-CGRP monoclonal antibodies.

RESULTS

A total of 11 patients with a diagnosis of migraine and 11 healthy controls were enrolled. The main findings of this study are the significant effects of anti-CGRP mAb treatment on the TMS parameters of intracortical inhibition and the rise in the resting motor threshold in our group of patients affected by resistant migraine. The clinical effect of therapy on migraine is associated with the increase in short-interval intracortical inhibition (SICI), resting motor threshold (RMT), and Pressure Pain Threshold (PPT). In all patients, all clinical headache parameters improved significantly 3 months after the first injection of mAbs and the improvement was maintained at the 1-month follow-up. At baseline, migraineurs and HCs had significant differences in all TMS parameters and in PPT, while at follow-up assessment, no differences were observed on RMT, SICI, and PPT between the two groups. After anti-CGRP monoclonal antibody injection, a significant increase in the intracortical inhibition, in the motor threshold, and in the Pressure Pain Threshold in critical head areas was observed in patients with migraine, which was related to significant clinical benefits.

CONCLUSIONS

Anti-CGRP monoclonal antibodies improved clinical and neurophysiological outcomes, reflecting a normalization of cortical excitability and peripheral and central sensitization. By directly acting on the thalamus or hypothalamus and indirectly on the trigeminocervical complex, treatment with anti-CGRP monoclonal antibodies may modulate central sensorimotor excitability and peripheral sensitization pain.

Alexithymia Increases Pericranial and Cervical Muscle Tenderness in Women with Migraine

Background/Objectives: Alexithymia is characterized by a deficit in identifying and communicating feelings. Emerging evidence suggests that alexithymia is highly prevalent in migraine, in a complex interplay with psychiatric comorbidity. Pericranial/cervical muscle tenderness is a remarkable clinical feature in a large proportion of migraine patients. This pilot study aimed at investigating the relationship between alexithymia and pericranial/cervical muscle tenderness in female migraineurs. Methods: A total of 42 female patients fulfilling the diagnostic criteria for migraine were enrolled into this pilot, observational, cross-sectional study after informed consent was obtained. Each patient underwent a psychological assessment to identify any alexithymia by means of TAS-20, anxiety/mood comorbidity (by means of STAI-Y1 STAI-Y2, BDI-II), and migraine-related disability (by means of HIT-6), and a physical cranial/cervical musculoskeletal examination. Palpation of pericranial and cervical muscles was carried out in the standardized manner. A Cumulative Muscle Tenderness (CUM) score (0-6) was calculated for each patient. A multivariate analysis was performed to investigate any association amongst the TAS-20 score, the CUM score, and the following covariates: BDI-II, STAI-Y1, STAI-Y2, and HIT-6 scores, age, disease duration, monthly migraine days, and average head pain intensity in the previous three months. Results: Overall, 35.6% of the sample had alexithymia. The multivariate analysis detected a linear and independent relationship between the TAS-20 and CUM scores, with a statistically significant (p = 0.017) association. Conclusions: This pilot study suggests that alexithymia plays a role in increasing pericranial/cervical muscle tenderness in migraine, independently from psychiatric comorbidity. A novel therapeutical approach, targeting alexithymia, may well reduce muscular tenderness in female migraineurs.

Pediatric Migraine and Visual Cortical Excitability: A Prospective Observational Study with Sound-Induced Flash Illusions

The pathophysiological mechanisms underlying migraine are more difficult to investigate in children than in the adult population. Abnormal cortical excitability turns out to be one of the most peculiar aspects of migraine, accounting for the manifestations of migraine attacks. Recently, visual cortical excitability has been explored effectively in adult migraineurs with a technique based on cross-modal audio-visual illusions (with sound-induced flash illusions (SIFIs) being reduced in migraineurs compared to non-migraineur subjects). On such a basis, in this study, we investigated visual cortical excitability in children with migraine using SIFIs using combinations of visual and sound stimuli presented randomly. We evaluated 26 children with migraine without aura and 16 healthy children. Migraineurs did not differ from the age-matched healthy subjects regarding fission or fusion illusions but perceived more flashes in trials of multiple flashes with or without beeps. The higher number of SIFIs in migraineur children compared to adults may be due to a greater propensity of visual stimulation to be driven by auditory stimuli (i.e., acoustic dominance). The increased ability to perceive flashes reveals a hyperfunctional visual cortex, demonstrating that the use of SIFIs is a valid tool for assessing visual cortical responsiveness even in pediatric migraine.