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Khedr EM, Abbas MA, Gamea A, Sadek MA, Zaki AF. Cerebrovascular reactivity after functional activation of the Brain using Photic Stimulation in Migraine and Tension Type Headache: a transcranial doppler Ultrasonography Study. BMC Neurol 2023; 23:110. [PMID: 36932355 PMCID: PMC10021977 DOI: 10.1186/s12883-023-03153-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Previous studies in headache patients measured the cerebrovascular reactivity (CVR) in response to photic stimulation but they have yielded contradictory results. The purpose of study was to measure CVR of both migraine and chronic tension headache (TTH) patients in response to photic stimulation. METHODS The study included 37 migraineurs and 24 chronic TTH patients compared with 50 age- and sex-matched healthy volunteers. Peak systolic, end diastolic, mean flow velocities and CVR (PSV, EDV, MFV, and CVR) were measured using TCD ultrasonography of the middle, anterior, posterior cerebral and vertebral arteries (MCA, ACA, PCA, and VA) before and after 100 s of 14 Hz photic stimulation. RESULTS A three-way repeated measures ANOVA interaction with main factors of Vessels (MCA, ACA, PCA, VA), Time (pre-post photic) and Groups (migraine, TTH, and control group) revealed significant 3-way interactions for measures of PSV (P = 0.012) and MFV (P = 0.043). In the migraine patients there was significantly higher PSV, EDV, and MFV in the MCA, ACA, and PCA after photic stimulation compared with baseline. The CVR of the MCA was also significantly higher in migraineurs than controls. In the TTH group, there was significantly higher PSV, EDV, and MFV (P = 0.003, 0.012, 0.002 respectively) in the VA after photic stimulation than at baseline. The CVR was significantly higher in the VA of TTH patients than controls. CONCLUSION Compared with controls after photic stimulation, the higher CVR of the MCA in migraineurs and of the VA in TTH patients could be used as diagnostic tool to differentiate between the two types of headaches.
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Affiliation(s)
- Eman M Khedr
- Department of Neuropsychiatry, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt.
- Neuropsychiatric Department, Faculty of Medicine, Aswan University Hospital, Aswan, Egypt.
| | - Mohammed A Abbas
- Neuropsychiatry department Faculty of Medicine, Luxor University, Luxor, Egypt
| | - Ayman Gamea
- Neuropsychiatric Department, Faculty of Medicine, South Valley University, Qena University Hospital, Qena, Egypt
| | - Mohamed A Sadek
- Neuropsychiatric Department, Faculty of Medicine, South Valley University, Qena University Hospital, Qena, Egypt
| | - Ahmed F Zaki
- Neuropsychiatric Department, Faculty of Medicine, South Valley University, Qena University Hospital, Qena, Egypt
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Aguila MER, Rebbeck T, Pope A, Ng K, Leaver AM. Six-month clinical course and factors associated with non-improvement in migraine and non-migraine headaches. Cephalalgia 2017; 38:1672-1686. [DOI: 10.1177/0333102417744360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Evidence on the medium-term clinical course of recurrent headaches is scarce. This study explored the six-month course and factors associated with non-improvement in migraine compared with tension-type headache and cervicogenic headache. Methods In this longitudinal cohort study, the six-month course of headaches was prospectively examined in participants (n = 37 with migraine; n = 42 with tension-type or cervicogenic headache). Participants underwent physical examination for cervical musculoskeletal impairments at baseline. Participants also completed questionnaires on pain, disability and other self-report measures at baseline and follow-up, and kept an electronic diary for 6 months. Course of headaches was examined using mixed within-between analyses of variance and Markov chain modeling. Multiple factors were evaluated as possible factors associated with non-improvement using regression analysis. Results Headache frequency, intensity, and activity interference in migraine and non-migraine headaches were generally stable over 6 months but showed month-to-month variations. Day-to-day variations were more volatile in the migraine than the non-migraine group, with the highest probability of transitioning from any headache state to no headache (probability = 0.82–0.85). The odds of non-improvement in disability was nearly six times higher with cervical joint dysfunction (odds ratio [95% CI] = 5.58 [1.14–27.42]). Conclusions Headache frequency, intensity, and activity interference change over 6 months, with day-to-day variation being more volatile in migraine than non-migraine headaches. Cervical joint dysfunction appears to be associated with non-improvement for disability in 6 months. These results may contribute to strategies for educating patients to help align their expectations with the nature of their headaches.
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Affiliation(s)
- Maria-Eliza R Aguila
- University of Sydney Faculty of Health Sciences, Sydney, New South Wales, Australia
- University of the Philippines College of Allied Medical Professions, Manila, Philippines
| | - Trudy Rebbeck
- University of Sydney Faculty of Health Sciences, Sydney, New South Wales, Australia
- John Walsh Centre of Rehabilitation Research, Kolling Institute of Medical Research Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Alun Pope
- Statistical Consulting, University of Sydney, Sydney, New South Wales, Australia
| | - Karl Ng
- Department of Neurology, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew M Leaver
- University of Sydney Faculty of Health Sciences, Sydney, New South Wales, Australia
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Lee MJ, Chu MK, Choi H, Choi HA, Lee C, Chung CS. Longitudinal changes in cerebral blood flow velocities in different clinical courses of migraine. Cephalalgia 2016; 37:927-937. [PMID: 27381854 DOI: 10.1177/0333102416658715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To assess longitudinal changes in cerebral blood flow velocities (ΔCBFVs) according to the clinical course of migraine. Methods We retrospectively included migraine patients with two or more attacks per month at baseline who were followed up within 2 years with transcranial Doppler in a tertiary headache clinic. ΔCBFVs were analyzed in relation to clinical courses, defined as remission (0-1 headache days/month), persistence (2-14/month), or progression (≥15/month) in episodic migraine (EM), and conversion to EM (<15/month) and persistence (≥15/month) in chronic migraine (CM). Results A total of 166 patients (90 EM and 76 CM) were included. In EM, the remission group ( n = 30) showed a decrease in CBFV in the middle cerebral artery (MCA) and the basilar artery (BA). The progression group ( n = 10) showed increasing CBFVs in the bilateral MCAs. Patients with the persistence course ( n = 50) showed generally unchanged CBFVs. In CM, ΔCBFVs decreased in the BA and increased in the posterior cerebral artery (PCA) after conversion to EM ( n = 61), whereas they remained unchanged in the persistence group ( n = 15). In all patients, % change in headache days was positively correlated with the %ΔCBFVs of the bilateral MCAs and the BA. Conclusions CBFV changes are associated with the different clinical courses of migraine. The association is more prominent in EM than CM.
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Affiliation(s)
- Mi Ji Lee
- 1 Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Kyung Chu
- 2 Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hanna Choi
- 3 Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Hyun Ah Choi
- 1 Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chungbin Lee
- 1 Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chin-Sang Chung
- 1 Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Cseh A, Farkas KM, Derzbach L, Muller K, Vasarhelyi B, Szalay B, Treszl A, Farkas V. Lymphocyte subsets in pediatric migraine. Neurol Sci 2012; 34:1151-5. [DOI: 10.1007/s10072-012-1218-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 10/05/2012] [Indexed: 11/30/2022]
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Salhofer-Polanyi S, Frantal S, Brannath W, Seidel S, Wöber-Bingöl Ç, Wöber C. Prospective Analysis of Factors Related to Migraine Aura - The PAMINA Study. Headache 2012; 52:1236-45. [DOI: 10.1111/j.1526-4610.2012.02166.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Lieba‐Samall D, Wöberl C, Frantall S, Brannathl W, Schmidtl K, Schrolnbergerl C, Wöber‐Bingöll Ç. Headache, menstruation and combined oral contraceptives: A diary study in 184 women with migraine. Eur J Pain 2012; 15:852-7. [DOI: 10.1016/j.ejpain.2011.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 02/04/2011] [Accepted: 02/14/2011] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Sophie Frantall
- Department of Medical Statistics, Medical University of Vienna, Austria
| | - Werner Brannathl
- Department of Medical Statistics, Medical University of Vienna, Austria
| | - Karin Schmidtl
- Department of Neurology, Medical University of Vienna, Austria
| | | | - Çicek Wöber‐Bingöll
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Austria
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Characteristics, impact and treatment of 6000 headache attacks: The PAMINA study. Eur J Pain 2012; 15:205-12. [PMID: 20655777 DOI: 10.1016/j.ejpain.2010.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 06/01/2010] [Accepted: 06/16/2010] [Indexed: 11/24/2022]
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Seidel S, Lieba-Samal D, Vigl M, Wöber C. Clinical features of unilateral headaches beyond migraine and cluster headache and their response to indomethacin. Wien Klin Wochenschr 2011; 123:536-41. [PMID: 21833596 DOI: 10.1007/s00508-011-0035-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 06/23/2011] [Indexed: 11/28/2022]
Abstract
The majority of previous studies on unilateral headaches beyond migraine and cluster headache have focussed on certain disorders such as paroxysmal hemicrania, SUNCT and primary stabbing headache. We assessed headache characteristics, importance of neuroimaging and response to indomethacin in an unselected series of uncommon unilateral headaches. We investigated all consecutive patients presented with unilateral headaches not fulfilling ICHD-II criteria of migraine and cluster headache. Patients underwent cranial magnetic resonance imaging or computed tomography as well as an indo-test, i.e. oral indomethacin 75 mg b.i.d. for 3 days. Among 63 patients we diagnosed primary stabbing headache in 12 patients, (probable) paroxysmal hemicrania in 6 and tension-type headache in 3 patients. One patient each had probable SUNCT, new daily persistent headache and nasociliary neuralgia. Eight patients had a secondary headache and 31 could not be classified according to ICDH-II. Imaging revealed lesions causally related to the headache in 8 patients. Indo-test achieved full remission of headache in 13 of 51 patients. At follow-up 11 ± 3 months after the first visit 29% of the patients were headache-free for ≥3 months. In conclusion, almost half of the patients presented with unilateral headaches beyond migraine and cluster headache cannot be classified according to ICHD-II. Among classifiable headaches primary stabbing headache was the most common. Imaging should be considered to rule out secondary headaches. The course is favourable in one third of the patients.
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Affiliation(s)
- Stefan Seidel
- Department of Neurology, Medical University of Vienna, Vienna, Austria.
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Salhofer S, Lieba-Samal D, Freydl E, Bartl S, Wiest G, Wöber C. Migraine and vertigo – a prospective diary study. Cephalalgia 2010; 30:821-8. [DOI: 10.1177/0333102409360676] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of the study was to examine migrainous vertigo prospectively by means of a diary. We included 146 patients with at least one migraine attack per month. All patients underwent a semistructured interview, completed questionnaires on depression, anxiety and quality of sleep and kept a diary covering detailed information on headache, vertigo and dizziness over a period of 30 days. A completed diary was returned by 116 patients (79.5%). Based on the diary migrainous vertigo (MV) was diagnosed in 18 patients (15.5%) and non-migrainous vertigo or dizziness (non-MV) in 35 patients (30.2%). MV was present on 65 of 3477 patient days (1.9%) and non-MV on 145 days (4.2%). MV occurred more often on days with headache ( P < 0.001). Its median duration was 3 h and it lasted longer on days with headache than on days without headache ( P < 0.001). The most prominent specific feature of MV was head motion intolerance. Patients with MV showed anxiety more often ( P < 0.001) and tended to have worse quality of sleep and higher depression scores. In conclusion, vertigo and dizziness are frequent symptoms in migraineurs. The 1-month prevalence of MV is 16% and that of non-MV 30% in patients with at least one migraine attack per month. Frequency of MV is higher and duration longer on days with headache. MV is a risk factor for co-morbid anxiety.
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Affiliation(s)
- Sabine Salhofer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Doris Lieba-Samal
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Freydl
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sigrid Bartl
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gerald Wiest
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Christian Wöber
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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