Updates on migraine epidemiology

Vitamin D in Neurological Diseases

Vitamin D may have multiple effects on the nervous system and its deficiency can represent a possible risk factor for the development of many neurological diseases. Recent studies are also trying to clarify the different effects of vitamin D supplementation over the course of progressive neurological diseases. In this narrative review, we summarise vitamin D chemistry, metabolism, mechanisms of action, and the recommended daily intake. The role of vitamin D on gene transcription and the immune response is also reviewed. Finally, we discuss the scientific evidence that links low 25-hydroxyvitamin D concentrations to the onset and progression of severe neurological diseases, such as multiple sclerosis, Parkinson's disease, Alzheimer's disease, migraine, diabetic neuropathy and amyotrophic lateral sclerosis. Completed and ongoing clinical trials on vitamin D supplementation in neurological diseases are listed.

Efficacy of contralateral acupuncture in women with migraine without aura: protocol for a randomised controlled trial

INTRODUCTION

Migraine is a common neurological disorder with a higher prevalence occurring in women. Migraine without aura (MwoA) is the most common type of migraine. In recent years, the safety and effectiveness of acupuncture for migraines have been internationally recognised. Contralateral acupuncture (CAT) (Jùcì) is an ancient classic acupuncture technique from Huang Di Nei Jing that refers to the acupoints on the right side (healthy side) selected for diseases on the left (affected side) and vice versa. Some studies have shown that efficacy of CAT on the painful disorder is even better than ipsilateral acupuncture (IAT), but there remains a lack of high-quality evidence to support it.

METHODS AND ANALYSIS

This is a single-centre, randomised and sham-controlled clinical trial in China with three parallel groups that aim to evaluate the efficacy of CAT in women with unilateral MwoA. 243 participants will be randomly divided into the experimental group (CAT group), control group 1 (IAT group) and control group 2 (sham acupuncture group) (1:1:1 allocation ratio). Each group will be given 30-minute treatment sessions, once every other day, approximately three times per week, for a total of 24 treatments and follow-up visits two times. The primary outcome is the changes in days of migraine attacks. The secondary outcomes are frequency of migraine attacks, intensity of migraine, migraine duration, the dose of intake of acute medication, the Migraine-Specific Quality of Life Questionnaire, the Migraine Disability Assessment Score, the Headache Impact Test-6 and the Pittsburgh Sleep Quality Index. The data will be collected at the baseline time (week 0), end of treatment (week 4-8) and the follow-up time (week 12-16). Adverse events will be collected and recorded during each treatment.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Ethics Committee of the Sports Trauma Specialist Hospital of Yunnan Province (2021-01). All participants will provide written informed consent before randomisation. The results of this study will be published in a peer-reviewed journal and presented at conferences.

TRIAL REGISTRATION NUMBER

Chinese Clinical Trial Registration Center (ChiCTR2100051479).

Managing of Migraine in the Workplaces: Knowledge, Attitudes and Practices of Italian Occupational Physicians

Background and Objectives: Migraine is a debilitating disorder, whose incidence peak in the age group of 30-39 years overlaps with the peak of employment years, potentially representing a significant issue for occupational physicians (OP). The present study was performed in order to characterize their knowledge, attitudes and practices on migraine in the workplaces. Materials and Methods: A convenience sample of 242 Italian OP (mean age 47.8 ± 8.8 years, males 67.4%) participated in an internet-based survey by completing a structured questionnaire. Results: Adequate general knowledge of migraine was found in the majority of participants. Migraine was identified as a common and severe disorder by the majority of respondents (54.0% and 60.0%). Overall, 61.2% of participants acknowledged migraine as difficult to manage in the workplace, a status that made it more likely for OP understanding its potential frequency (Odds Ratio [OR] 3.672, 95% confidence interval [95%CI] 1.526-8.831), or reported previous managing of complicated cases requiring conditional fitness to work judgement (OR 4.761, 95%CI 1.781-2.726). Moreover, professionals with a qualification in occupational medicine (OR 20.326, 95%CI 2.642-156.358), acknowledging the difficult managing of migraine in the workplaces (OR 2.715, 95%CI 1.034-7.128) and having received any request of medical surveillance for migraine (OR 22.878, 95%CI 4.816-108.683), were more likely to recommend specific requirements for migraineur workers. Conclusions: Migraine was recognized as a common disorder, but also as a challenging clinical problem for OP. Participating OP exhibited a substantial understanding of migraine and its triggers, but residual false beliefs and common misunderstanding may impair the proper management of this disorder, requiring improved and specifically targeted interventions.

Alcohol, coffee consumption, and smoking in relation to migraine: a bidirectional Mendelian randomization study

ABSTRACT

We conducted a Mendelian randomization study to assess whether alcohol and coffee consumption and smoking are causally associated with risk of developing migraine. Independent single-nucleotide polymorphisms associated with the potential risk factors at P < 5 × 10-8 in large-scale genome-wide association studies were selected as instrumental variables. Summary-level data for the associations of the selected single-nucleotide polymorphisms with migraine were obtained from the FinnGen consortium comprising 6687 cases and 144,780 noncases and the UK Biobank study comprising 1072 cases and 360,122 noncases. Estimates derived from the FinnGen and UK Biobank cohorts were combined using fixed-effects meta-analysis. We found evidence for associations of genetically predicted alcohol consumption (odds ratio [OR] 0.54 per SD increase in log-transformed alcoholic drinks per week, 95% confidence interval [CI], 0.35-0.82; P = 0.004), coffee consumption (OR 0.56 per 50% increase in coffee consumption, 95% CI, 0.45-0.70; P < 0.001), and smoking initiation (OR 1.15 for one SD increase in the prevalence of smoking initiation, 95% CI, 1.01-1.31; P = 0.038). These associations persisted in sensitivity analyses, including mutual adjustment in multivariable Mendelian randomization analyses. In reverse Mendelian randomization analyses, genetic liability to migraine was inversely associated with alcohol consumption but was not associated with coffee consumption or smoking initiation. This study provides genetic evidence in support of a protective role of moderate coffee consumption and a detrimental role of cigarette smoking in the etiology of migraine. The inverse association between alcohol consumption and migraine risk may be attributable to reverse causality.

Association Between Insomnia and Migraine Risk: A Case-Control and Bidirectional Mendelian Randomization Study

Background

The causal relationship between insomnia and migraine is contradictory and no study has been carried out among the Chinese population to date.

Methods

In this case, we conducted a case–control study and a bidirectional mendelian randomization (MR) analysis to determine whether insomnia is causally related to the development of migraine. The instrumental variables for insomnia were derived from the largest genome-wide association study of 1,331,010 participants, while the genetic instruments for migraine were available from the largest meta-analysis of migraine with 59,674 cases and 316,078 controls.

Results

In case–control study, subjects with insomnia have significantly higher risk of migraine (OR=4.29, 95% CI: 3.21–5.74, P<0.001), compared with those without insomnia. The bidirectional two-sample MR analysis revealed that insomnia was significantly associated with higher risk of migraine (OR=1.24, 95% CI: 1.11–1.38, P=1.01×10-4), and the results were validated in the UK Biobank data. The results showed no indication for directional pleiotropy effects as assessed by the MR-Egger intercept (P>0.05).

Conclusion

Conclusively, our study highlighted that increased migraine risk was confined to subjects with a genetic pre-disposition to insomnia, and these findings had potential implications for improving the sleep quality to reduce the burden of migraine.

The "olfactory fingerprint": can diagnostics be improved by combining canine and digital noses?

A sniffer (detecting) dog is conventionally defined as an animal trained to use its olfactory perceptions for detecting a vast array of substances, mostly volatile organic compounds (VOCs), including those exceptionally or exclusively generated in humans bearing specific pathologies. Such an extraordinary sniffing performance translates into the capability of detecting compounds close to the femtomolar level, with performance comparable to that of current mass spectrometry-based laboratory applications. Not only can dogs accurately detect "abnormal volatilomes" reflecting something wrong happening to their owners, but they can also perceive visual, vocal and behavioral signals, which altogether would contribute to raise their alertness. Although it seems reasonable to conclude that sniffer dogs could never be considered absolutely "diagnostic" for a given disorder, several lines of evidence attest that they may serve as efficient screening aids for many pathological conditions affecting their human companions. Favorable results have been obtained in trials on cancers, diabetes, seizures, narcolepsy and migraine, whilst interesting evidence is also emerging on the capability of early and accurately identifying patients with infectious diseases. This would lead the way to proposing an "olfactory fingerprint" loop, where evidence that dogs can identify the presence of human pathologies provides implicit proof of the existence of disease-specific volatilomes, which can be studied for developing laboratory techniques. Contextually, the evidence that specific pathologies are associated with abnormal VOC generation may serve as reliable basis for training dogs to detect these compounds, even (or especially) in patients at an asymptomatic phase.

Riboflavin in Neurological Diseases: A Narrative Review

Riboflavin is classified as one of the water-soluble B vitamins. It is part of the functional group of flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD) cofactors and is required for numerous flavoprotein-catalysed reactions. Riboflavin has important antioxidant properties, essential for correct cell functioning. It is required for the conversion of oxidised glutathione to the reduced form and for the mitochondrial respiratory chain as complexes I and II contain flavoprotein reductases and electron transferring flavoproteins. Riboflavin deficiency has been demonstrated to impair the oxidative state of the body, especially in relation to lipid peroxidation status, in both animal and human studies. In the nervous system, riboflavin is essential for the synthesis of myelin and its deficiency can determine the disruption of myelin lamellae. The inherited condition of restricted riboflavin absorption and utilisation, reported in about 10-15% of world population, warrants further investigation in relation to its association with the main neurodegenerative diseases. Several successful trials testing riboflavin for migraine prevention were performed, and this drug is currently classified as a Level B medication for migraine according to the American Academy of Neurology evidence-based rating, with evidence supporting its efficacy. Brown-Vialetto-Van Laere syndrome and Fazio-Londe diseases are now renamed as "riboflavin transporter deficiency" because these are autosomal recessive diseases caused by mutations of SLC52A2 and SLC52A3 genes that encode riboflavin transporters. High doses of riboflavin represent the mainstay of the therapy of these diseases and high doses of riboflavin should be rapidly started as soon as the diagnosis is suspected and continued lifelong. Remarkably, some mitochondrial diseases respond to supplementation with riboflavin. These include multiple acyl-CoA-dehydrogenase deficiency (which is caused by ETFDH gene mutations in the majority of the cases, or mutations in the ETFA and ETFB genes in a minority), mutations of ACAD9 gene, mutations of AIFM1 gene, mutations of the NDUFV1 and NDUFV2 genes. Therapeutic riboflavin administration has been tried in other neurological diseases, including stroke, multiple sclerosis, Friedreich's ataxia and Parkinson's disease. Unfortunately, the design of these clinical trials was not uniform, not allowing to accurately assess the real effects of this molecule on the disease course. In this review we analyse the properties of riboflavin and its possible effects on the pathogenesis of different neurological diseases, and we will review the current indications of this vitamin as a therapeutic intervention in neurology.

Different Chinese patent medicine therapies for migraine: A protocol for systematic review and network meta-analysis

BACKGROUND

Migraine is a clinically high incidence rate of neurovascular disease. It is a recurrent headache. It is characterized by nausea, vomiting, fear of voice, and photophobia. Nowadays, a large number of randomized controlled clinical studies have shown that Chinese patent medicine has the advantages of good curative effect and high safety in the treatment of migraine. However, due to the variety of proprietary Chinese medicines, their relative effectiveness and safety have not yet been verified. Therefore, this study will use the network meta-analysis method to verify the effectiveness and safety of different kinds of Chinese patent medicines in the treatment of migraine.

METHODS

All randomized controlled trials of Toutongning capsule, Yangxue Qingnao granule, naoxintong capsules, Tianmagouteng granules in the treatment of migraine were searched from PubMed, Cochrane Library, web of science, EMBASE, sinomed, CNKI, Wanfang database, VIP. The retrieval time is from the establishment of the database to November 18, 2020. In order to avoid omission, we will manually retrieve relevant references and conference papers. According to the inclusion and exclusion criteria, we evaluated the quality and risk of all the retrieved literatures. Methodological quality assessment and bias risk will be assessed using the Cochrane bias risk tool. Revman 5.3, WinBUGS 1.4.3, and stata14.2 software will be used for all data analysis.

RESULTS

This study will directly or indirectly compare the effectiveness of different interventions on migraine outcome indicators, and rank the effectiveness. The main outcome measures included total effective rate (total effective rate = rocovery + obvious effective + effective/total number of cases × 100%), visual analogue scale (VAS) score, and secondary outcome indicators included analgesic effect evaluation index and quality of life scale.

CONCLUSION

To provide evidence for evidence-based medicine and clinical researchers to choose more effective Chinese patent medicines to treat migraine.