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Blaustein MP, Hamlyn JM. Sensational site: the sodium pump ouabain-binding site and its ligands. Am J Physiol Cell Physiol 2024; 326:C1120-C1177. [PMID: 38223926 DOI: 10.1152/ajpcell.00273.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/22/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
Cardiotonic steroids (CTS), used by certain insects, toads, and rats for protection from predators, became, thanks to Withering's trailblazing 1785 monograph, the mainstay of heart failure (HF) therapy. In the 1950s and 1960s, we learned that the CTS receptor was part of the sodium pump (NKA) and that the Na+/Ca2+ exchanger was critical for the acute cardiotonic effect of digoxin- and ouabain-related CTS. This "settled" view was upended by seven revolutionary observations. First, subnanomolar ouabain sometimes stimulates NKA while higher concentrations are invariably inhibitory. Second, endogenous ouabain (EO) was discovered in the human circulation. Third, in the DIG clinical trial, digoxin only marginally improved outcomes in patients with HF. Fourth, cloning of NKA in 1985 revealed multiple NKA α and β subunit isoforms that, in the rodent, differ in their sensitivities to CTS. Fifth, the NKA is a cation pump and a hormone receptor/signal transducer. EO binding to NKA activates, in a ligand- and cell-specific manner, several protein kinase and Ca2+-dependent signaling cascades that have widespread physiological effects and can contribute to hypertension and HF pathogenesis. Sixth, all CTS are not equivalent, e.g., ouabain induces hypertension in rodents while digoxin is antihypertensinogenic ("biased signaling"). Seventh, most common rodent hypertension models require a highly ouabain-sensitive α2 NKA and the elevated blood pressure is alleviated by EO immunoneutralization. These numerous phenomena are enabled by NKA's intricate structure. We have just begun to understand the endocrine role of the endogenous ligands and the broad impact of the ouabain-binding site on physiology and pathophysiology.
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Affiliation(s)
- Mordecai P Blaustein
- Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, United States
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - John M Hamlyn
- Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, United States
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Hajjarzadeh S, Bakhshimoghaddam F, Behrouz M, Nikniaz Z, Mahdavi R, Shalilahmadi D, Karandish M. The relation of adherence to the DASH diet with migraine attack frequency and pain intensity in Iranian women: a cross-sectional study. Nutr Neurosci 2024; 27:353-360. [PMID: 36976732 DOI: 10.1080/1028415x.2023.2193766] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Migraine is a debilitating neurological discomfort characterized by moderate to severe unilateral headaches. Adherence to healthy dietary patterns like the DASH diet has been considered a complementary solution to migraine management. OBJECTIVE In this study, we assessed the relation of adherence to the DASH diet with migraine attack frequency and pain intensity in women with migraine. METHODS 285 female women with migraine were recruited in the current study. Migraine was diagnosed by a single neurologist based on the third edition of the International Classification of Headache Disorders (ICHD-III). Migraine attack frequency was determined based on the number of attacks per month. Pain intensity was assessed by the Visual Analogue Scale (VAS) and migraine index. Last year dietary intakes of women were collected using a semi-quantitative food frequency questionnaire (FFQ). RESULTS Almost 91% of the women had migraine without aura. Most of the participants reported more than 15 attacks per month (40.7%) and pain intensity in the range of 8-10 in every attack (55.4%). Based on the ordinal regression, those in the first tertile of the DASH score had significantly higher odds for attack frequency (OR = 1.88; 95% CI: 1.11-3.18; P = .02) and migraine index score (OR = 1.69; 95% CI: 1.02-2.79; P = .04, respectively) than those in the third tertile. CONCLUSION This study showed that a higher DASH score is associated with a lower migraine attack frequency and migraine index score in female sufferers.
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Affiliation(s)
- Samaneh Hajjarzadeh
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Nutrition and Metabolic Diseases Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farnush Bakhshimoghaddam
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Nutrition and Metabolic Diseases Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Behrouz
- Clinical Research Development Unit of Children Educational, Research and Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Nikniaz
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Mahdavi
- School of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Davood Shalilahmadi
- School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Karandish
- Nutrition and Metabolic Diseases Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Xu L, Zhang C, Liu Y, Shang X, Huang D. Association between dietary potassium intake and severe headache or migraine in US adults: a population-based analysis. Front Nutr 2023; 10:1255468. [PMID: 37781118 PMCID: PMC10540813 DOI: 10.3389/fnut.2023.1255468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
Background Migraine is a prevalent neurovascular headache disorder. The link between dietary potassium and blood pressure has been established. We sought to delineate the relationship between dietary potassium intake and the prevalence of migraines. Methods We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999-2004, comprising 10,254 participants aged ≥20 years. Participants who reported severe headaches or migraine in the self-report questionnaire were identified as migraineurs. A 24-h dietary recall methodology was used to assess dietary potassium intake. Multivariate regression analysis and restricted cubic spline (RCS) modeling were utilized to elucidate the relationship between dietary potassium and migraines. Results Among the 10,254 participants, 20.1% were identified with migraine or severe headaches. The adjusted odds ratio (OR) for migraine occurrence in the Q2 dietary potassium intake (1771-2,476 mg/d) was 0.84 (95% CI: 0.73-0.97, p = 0.021) compared to the lowest quartile (Q1, ≤ 1771 mg/d). The relationship between dietary potassium and migraine exhibited an L-shaped pattern (non-linear, p = 0.016) with an inflection at approximately 1439.3 mg/d. In the subgroup analysis, when compared to Q1, who had the lowest dietary potassium intake, the adjusted OR for Q2 in females, those in the medium-high household income group, and with a Body Mass Index (BMI) ≥ 25 kg/m2 were as follows: (OR, 0.82; 95% CI, 0.69-0.98), (OR, 0.79; 95% CI, 0.66-0.95), and (OR, 0.78; 95% CI, 0.66-0.93), respectively. No significant interaction was observed across groups after adjusting for all possible covariates. Conclusion The relationship between dietary potassium intake and migraine prevalence among US adults appears to follow an L-shaped curve.
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Affiliation(s)
- Lisi Xu
- Department of The Second Cadre Ward, General Hospital of Northern Theater Command, Shen Yang, China
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shen Yang, China
| | - Cong Zhang
- Department of The Second Cadre Ward, General Hospital of Northern Theater Command, Shen Yang, China
| | - Yan Liu
- Department of The Second Cadre Ward, General Hospital of Northern Theater Command, Shen Yang, China
| | - Xiuli Shang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shen Yang, China
| | - Daifa Huang
- Department of The Second Cadre Ward, General Hospital of Northern Theater Command, Shen Yang, China
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Karimi E, Tirani SA, Azimi ES, Askari G, As’habi A, Arab A. Is there an association between a plant-based eating pattern and clinical findings of a migraine headache? Front Nutr 2023; 10:1117740. [PMID: 37469539 PMCID: PMC10352789 DOI: 10.3389/fnut.2023.1117740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/20/2023] [Indexed: 07/21/2023] Open
Abstract
Aims The present study was conducted among Iranian individuals diagnosed with migraine headaches to investigate the association between plant-based eating patterns and the clinical features of a migraine headache. Methods In total, 262 patients aged 20-50 years who were diagnosed with migraine headaches were included in the current cross-sectional study. Participants' dietary intake was assessed using a validated 168-item, semi-quantitative food frequency questionnaire (FFQ). Three versions of the plant-based diet index (PDI) comprising overall PDI, healthy PDI (hPDI), and unhealthy PDI (uPDI) were generated. Headache frequency, duration, and severity were assessed via a 30-day headache diary. Migraine-related disability was assessed with a validated version of the headache impact test (HIT-6) questionnaire. Serum nitric oxide (NO) was measured using the Griess method utilizing serum samples. Results After controlling for potential confounders, an increase in mean PDI score from 48.22 to 61.67 decreased the frequency of headaches by -2.95 (95% CI: 0.06, 0.53; ptrend = 0.005). PDI was inversely associated with serum levels of NO in those with the highest scores of PDI compared to those with the lowest scores after adjustment for confounders (β = -7.69; 95% CI: -14.68, -0.69; ptrend = 0.028). After adjustment for potential confounders, an increase in the mean hPDI score from 47.96 to 65.25 decreased serum levels of NO by -11.92 (95% CI: -19.74, -4.10; ptrend = 0.003). Conclusion Our findings suggest that higher adherence to a plant-based eating style, as evidenced by higher PDI and hPDI values, was significantly associated with lower headache frequency and serum levels of NO.
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Affiliation(s)
- Elham Karimi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
- Research Development Center, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahnaz Amani Tirani
- Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Sadat Azimi
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atefeh As’habi
- Food Safety Research Center (salt), Semnan University of Medical Sciences, Semnan, Iran
| | - Arman Arab
- Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Kang HS, Kim SY, Kim JH, Kim ES, Choi HG, Lim H, Kim JH, Park HY, Kim NY, Hong S, Choi KC, Kwon MJ. Association between Migraines and Prior Proton Pump Inhibitor Use: A Nested Case-Control Study Using a National Health Screening Cohort. Pharmaceuticals (Basel) 2022; 15:ph15111385. [PMID: 36355557 PMCID: PMC9694889 DOI: 10.3390/ph15111385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
The effect of proton pump inhibitor (PPI) use on migraine risk remains controversial. We explored the odds of migraines in relation to prior PPI use and treatment duration. Data from the Korean National Health Insurance Service-Health Screening Cohort (2002−2015) were analyzed in this nested case-control study involving 28,159 participants with incident migraines and 112,636 controls (1:4 matched by sex, age, income, and residential region). The baseline covariates were balanced by performing propensity score overlap weighting-based adjustments, and the effect of prior PPI use (past vs. current) and treatment duration (<30 and 30−365 days vs. ≥365 days) on incident migraines was evaluated using logistic regression. In past and current PPI users, prior PPI use raised the likelihood of migraines (adjusted odds ratio [95% confidence interval]: 2.56 [2.36−2.79] and 4.66 [4.29−5.06], respectively). Participants who used PPI for <30, 30−365, or ≥365 days exhibited high odds of migraines (2.49 [2.29−2.72], 4.41 [4.05−4.79], and 4.14 [3.77−4.54], respectively). Incident migraines with or without aura also increased independently of PPI use history or duration. In summary, prior PPI use, irrespective of the elapsed time since use and the duration of use, is possibly associated with incident migraines with or without aura.
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Affiliation(s)
- Ho Suk Kang
- Department of Internal Medicine, Division of Gastroenterology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea
| | - So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam 13488, Korea
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea
| | - Eun Soo Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea
| | - Hyun Lim
- Department of Internal Medicine, Division of Gastroenterology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea
| | - Joo-Hee Kim
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea
| | - Ha Young Park
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Korea
| | - Nan Young Kim
- Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang 14068, Korea
| | - Sangkyoon Hong
- Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang 14068, Korea
| | - Kyung Chan Choi
- Department of Pathology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 200060, Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea
- Correspondence:
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Christensen J, Li C, Mychasiuk R. Choroid plexus function in neurological homeostasis and disorders: The awakening of the circadian clocks and orexins. J Cereb Blood Flow Metab 2022; 42:1163-1175. [PMID: 35296175 PMCID: PMC9207490 DOI: 10.1177/0271678x221082786] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As research regarding the role of circadian rhythms, sleep, and the orexinergic system in neurodegenerative diseases is growing, it is surprising that the choroid plexus (CP) remains underappreciated in this realm. Despite its extensive role in the regulation of circadian rhythms and orexinergic signalling, as well as acting as the primary conduit between cerebrospinal fluid (CSF) and the circulatory system, providing a mechanism by which toxic waste molecules can be removed from the brain, the CP has been largely unexplored in neurodegeneration. In this review, we explore the role of the CP in maintaining brain homeostasis and circadian rhythms, regulating CSF dynamics, and how these functions change across the lifespan, from development to senescence. In addition, we examine the relationship between the CP, orexinergic signalling, and the glymphatic system, highlighting gaps in the literature and areas that require immediate exploration. Finally, we assess current knowledge, including possible therapeutic strategies, regarding the role of the CP in neurological disorders, such as traumatic brain injury, migraine, Alzheimer's disease, and multiple sclerosis.
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Affiliation(s)
- Jennaya Christensen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Crystal Li
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
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Is there a relationship between dietary sodium and potassium intake and clinical findings of a migraine headache? Br J Nutr 2022; 127:1839-1848. [PMID: 34378504 DOI: 10.1017/s000711452100283x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Few studies have assessed the association between sodium (Na) and potassium (K) and migraine headaches. In this study, we aimed to examine the relationship between 24-hour urine Na and K intakes and clinical findings of migraine in an Iranian sample. In this cross-sectional study, 262 participants, aged 20-50 years, were included with a body mass index (BMI) of 18·5-30 kg/m2 and a diagnosis of migraine. One 24-hour urine sample was collected from each subject to estimate the Na and K intakes. The clinical features of migraine, including frequency, duration, severity, Migraine Headache Index Score (MHIS), and Headache Impact Test (HIT) score, were assessed. Besides, a multiple linear regression analysis was performed, and beta estimates and the corresponding 95% confidence intervals (CIs) were reported. Overall, 224 women and 38 men, with a mean age of 36·10 years and BMI of 25·55 kg/m2 comprised our study population. After controlling for potential confounders, the 24-hour urine Na was positively associated with a longer headache duration (β = 0·29; 95% CI: 0·06, 0·53) in the group with the highest urine Na levels as compared to the group with the lowest levels. After adjustments for potential confounders, an increase of 13·05 in the MHIS was observed when the 24-hour urine Na level increased from the first to the third tertile (β = 13·05; 95% CI: 1·70, 24·41). Our findings suggested that a higher 24-hour urine Na level was positively associated with a longer duration of migraine headaches and a higher MHIS.
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Effects of the Dietary Approaches to Stop Hypertension (DASH) diet on clinical, quality of life, and mental health outcomes in women with migraine: A randomised controlled trial. Br J Nutr 2021; 128:1535-1544. [PMID: 34763733 DOI: 10.1017/s000711452100444x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The relationship between the Dietary Approaches to Stop Hypertension (DASH) diet and clinical, quality of life, and mental health outcomes in migraine is unknown. To address this knowledge gap, we conducted a parallel-group, randomised controlled trial to evaluate the effect of the DASH diet on these health outcomes in women with migraine. Of 102 eligible women (20-50 years), 51 randomised to the DASH and 51 to the usual dietary advice (control) groups completed a 12-week intervention. The DASH diet was designed using a 7-day menu cycle to provide 15-20% of total daily energy requirements from proteins, 25-30% from fats, and 55-60% from carbohydrates. Dietary records and serum vitamin C levels were used to assess women's compliance with the DASH diet. The clinical symptoms of migraine (i.e., frequency, duration, severity) and quality of life and mental health (i.e., depression, anxiety, stress) outcomes were assessed in groups pre-and post-intervention. We observed greater decreases in the frequency (-3.00 vs. -1.40, P=0.025) and severity (-1.76 vs. -0.59, P<0.001) of migraine in the DASH vs. control group post-intervention. Similarly, the DASH group exhibited a tendency toward greater decreases in migraine duration (-0.58 vs -0.33 days, P=0.053) and had lower scores of depression (-4.50 vs. -2.73, P=0.019) and stress (-5.84 vs -2.98, P=0.011) vs. controls. However, the quality of life and anxiety outcomes remained comparable in groups post-intervention. Together, evidence supports the benefits of the DASH diet on improving migraine health outcomes in reproductive-aged women. Further research is needed to confirm our findings.
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Gollion C. Cortical excitability in migraine: Contributions of magnetic resonance imaging. Rev Neurol (Paris) 2021; 177:809-815. [PMID: 34332777 DOI: 10.1016/j.neurol.2021.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022]
Abstract
Migraine is characterized by symptoms related to cortical hyperexcitability such as photophobia, phonophobia, osmophobia and allodynia. One-third of migraineurs experience aura, whose neurophysiological substrate is thought to be cortical spreading depression (CSD). Functional magnetic resonance imaging (MRI) has shown the migraine aura to be characterized by cerebral hyperactivity/hyperperfusion followed by hypometabolism/hypoperfusion spreading along the occipital cortex with the same spatiotemporal organization as the experimentally triggered CSD. The link between migraine aura and headache remains undetermined. Neuroimaging studies have failed to show a leakage of the blood-brain barrier, which was suspected to occur during CSD and to cause the stimulation of trigeminal nociceptive receptors. However, recent studies have highlighted the involvement of neuroglial inflammation and other studies have suggested that a common central network plays a role in the link between CSD and migraine pain. Finally, MRI has made it possible to study the contribution of metabolites such as glutamic acid, γ-amino-butyric acid and sodium in the pathophysiology of hyperexcitability in migraine.
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Affiliation(s)
- C Gollion
- Department of Neurology, University of Toulouse, Toulouse, France; ToNIC, Toulouse NeuroImaging Center, University of Toulouse, INSERM, Toulouse, France.
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10
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Arab A, Khorvash F, Karimi E, Heidari Z, Askari G. The effects of the dietary approaches to stop hypertension (DASH) diet on oxidative stress and clinical indices of migraine patients: a randomized controlled trial. Nutr Neurosci 2021; 25:2259-2268. [PMID: 34269164 DOI: 10.1080/1028415x.2021.1954294] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS The relationship between the Dietary Approaches to Stop Hypertension (DASH) diet and oxidative stress (OS) in patients diagnosed with migraine is unknown and remains to be examined. Hence, we conducted a parallel-group, randomized controlled trial to investigate this issue. METHODS Of the 102 women who met all the inclusion criteria, 51 individuals were randomized to the DASH diet group and 51 to the usual dietary advice group to receive allocated intervention for three months. In order to assess the compliance of participants to the DASH diet, dietary records, and serum vitamin C levels were examined. Parameters of OS status (e.g. nitric oxide (NO), total antioxidant capacity (TAC), total oxidative status (TOS), malondialdehyde (MDA), and oxidative stress index (OSI)) and clinical indices of migraine (e.g. migraine index (MI), headache dairy result (HDR), and migraine headache index score (MHIS)) were assessed at the beginning and the end of the study. RESULTS There was a significant reduction in NO (-5.75 vs. + 4.18, P = 0.025) and TOS (-1.55 vs. + 0.71, P = 0.034), and a marginally significant reduction in OSI (-0.10 vs. + 0.14, P = 0.060) in the DASH group compared with the control. Compliance with the DASH diet resulted in a significant decrease in the score of MI (-31.33 vs. - 15.09), HDR (-5.04 vs. -2.51), and MHIS (-44.21 vs. -26.74). Moreover, no significant change was observed in TAC, MDA, and total thiol content. CONCLUSION This type of dietary approach can be considered as a complementary treatment for migraine patients, also further investigations are needed to replicate our findings.Trial registration: Iranian Registry of Clinical Trials identifier: IRCT20121216011763N38.
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Affiliation(s)
- Arman Arab
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Karimi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Bharadwaj VN, Porreca F, Cowan RP, Kori S, Silberstein SD, Yeomans DC. A new hypothesis linking oxytocin to menstrual migraine. Headache 2021; 61:1051-1059. [PMID: 34125955 DOI: 10.1111/head.14152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/05/2021] [Accepted: 04/07/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To highlight the emerging understanding of oxytocin (OT) and oxytocin receptors (OTRs) in modulating menstrual-related migraine (MRM). BACKGROUND MRM is highly debilitating and less responsive to therapy, and attacks are of longer duration than nonmenstrually related migraine. A clear understanding of the mechanisms underlying MRM is lacking. METHODS We present a narrative literature review on the developing understanding of the role of OT and the OTR in MRM. Literature on MRM on PubMed/MEDLINE database including clinical trials and basic science publications was reviewed using specific keywords. RESULTS OT is a cyclically released hypothalamic hormone/neurotransmitter that binds to the OTR resulting in inhibition of trigeminal neuronal excitability that can promote migraine pain including that of MRM. Estrogen regulates OT release as well as expression of the OTR. Coincident with menstruation, levels of both estrogen and OT decrease. Additionally, other serum biochemical factors, including magnesium and cholesterol, which positively modulate the affinity of OT for OTRs, both decrease during menstruation. Thus, during menstruation, multiple menstrually associated factors may lead to decreased circulating OT levels, decreased OT affinity for OTR, and decreased expression of the trigeminal OTR. Consistent with the view of migraine as a threshold disorder, these events may collectively result in decreased inhibition promoting lower thresholds for activation of meningeal trigeminal nociceptors and increasing the likelihood of an MRM attack. CONCLUSION Trigeminal OTR may thus be a novel target for the development of MRM therapeutics.
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Affiliation(s)
- Vimala N Bharadwaj
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA, USA.,Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | - Frank Porreca
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | - Robert P Cowan
- Department of Neurology, School of Medicine, Stanford University, Stanford, CA, USA
| | | | | | - David C Yeomans
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA, USA
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Cowan RP, Gross NB, Sweeney MD, Sagare AP, Montagne A, Arakaki X, Fonteh AN, Zlokovic BV, Pogoda JM, Harrington MG. Evidence that blood-CSF barrier transport, but not inflammatory biomarkers, change in migraine, while CSF sVCAM1 associates with migraine frequency and CSF fibrinogen. Headache 2021; 61:536-545. [PMID: 33724462 PMCID: PMC8023403 DOI: 10.1111/head.14088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/29/2020] [Accepted: 01/24/2021] [Indexed: 02/07/2023]
Abstract
Objective Our objective is to explore whether blood–cerebrospinal fluid (CSF) barrier biomarkers differ in episodic migraine (EM) or chronic migraine (CM) from controls. Background Reports of blood–brain barrier and blood–cerebrospinal fluid barrier (BCSFB) disruption in migraine vary. Our hypothesis is that investigation of biomarkers associated with blood, CSF, brain, cell adhesion, and inflammation will help elucidate migraine pathophysiology. Methods We recruited 14 control volunteers without headache disorders and 42 individuals with EM or CM as classified using the International Classification of Headache Disorders, 3rd edition, criteria in a cross‐sectional study located at our Pasadena and Stanford headache research centers in California. Blood and lumbar CSF samples were collected once from those diagnosed with CM or those with EM during two states: during a typical migraine, before rescue therapy, with at least 6/10 level of pain (ictal); and when migraine free for at least 48 h (interictal). The average number of headaches per month over the previous year was estimated by those with EM; this enabled comparison of biomarker changes between controls and three headache frequency groups: <2 per month, 2–14 per month, and CM. Blood and CSF biomarkers were determined using antibody‐based methods. Results Antimigraine medication was only taken by the EM and CM groups. Compared to controls, the migraine group had significantly higher mean CSF–blood quotients of albumin (Qalb: mean ± standard deviation (SD): 5.6 ± 2.3 vs. 4.1 ± 1.9) and fibrinogen (Qfib mean ± SD: 1615 ± 99.0 vs. 86.1 ± 55.0). Mean CSF but not plasma soluble vascular cell adhesion molecule‐1 (sVCAM‐1) levels were significantly higher in those with more frequent migraine: (4.5 ng/mL ± 1.1 in those with <2 headache days a month; 5.5 ± 1.9 with 2–14 days a month; and 7.1 ± 2.9 in CM), while the Qfib ratio was inversely related to headache frequency. We did not find any difference in individuals with EM or CM from controls for CSF cell count, total protein, matrix metalloproteinase‐9, soluble platelet‐derived growth factor receptor β, tumor necrosis factor‐alpha, interferon‐gamma, interleukin (IL)‐6, IL‐8, IL‐10, or C‐reactive protein. Conclusions The higher Qalb and Qfib ratios may indicate that the transport of these blood‐derived proteins is disturbed at the BCSFB in persons with migraine. These changes most likely occur at the choroid plexus epithelium, as there are no signs of typical endothelial barrier disruption. The most striking finding in this hypothesis‐generating study of migraine pathophysiology is that sVCAM‐1 levels in CSF may be a biomarker of higher frequency of migraine and CM. An effect from migraine medications cannot be excluded, but there is no known mechanism to suggest they have a role in altering the CSF biomarkers.
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Affiliation(s)
- Robert P Cowan
- Department of Neurology, Stanford University, Palo Alto, CA, USA
| | - Noah B Gross
- Neurosciences, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Melanie D Sweeney
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Abhay P Sagare
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Axel Montagne
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Xianghong Arakaki
- Neurosciences, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Alfred N Fonteh
- Neurosciences, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Berislav V Zlokovic
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Michael G Harrington
- Neurosciences, Huntington Medical Research Institutes, Pasadena, CA, USA.,Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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13
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Teggi R, Colombo B, Zagato L, Filippi M. Could ionic regulation disorders explain the overlap between meniere's disease and migraine? J Vestib Res 2021; 31:297-301. [PMID: 33579883 DOI: 10.3233/ves-200788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ménière's disease (MD) is an inner ear disorder characterized by a burden of symptoms and comorbidities, including migraine. In both disorders, ionic dysregulation may play a role as a predisposing factor. In recent years. aquaporins have been widely investigated, but the results are far from conclusive. We recently studied the genetics of ionic transporters and the hormone endogenous ouabain as predisposing factors for development of MD. In particular, we found two genetic polymorphisms associated with MD: 1) rs3746951, a missense variant (Gly180Ser) in the salt-inducible kinase-1 (SIK1) gene encoding a Na+, K+ ATPase; 2) rs487119, an intronic variant of gene SLC8A1 coding for a Na+, Ca++ exchanger (NCX-1). Ionic concentration in the brain also plays a role in the pathophysiology of migraine. In this brief review we summarize what has been published on MD and migraine.
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Affiliation(s)
- Roberto Teggi
- Division of Otolaryngology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Bruno Colombo
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Zagato
- Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neuroimaging Research Unit, INSPE, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-SaluteSan Raffaele University, Milan, Italy
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14
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Ghaffari H, Grant SC, Petzold LR, Harrington MG. Regulation of CSF and Brain Tissue Sodium Levels by the Blood-CSF and Blood-Brain Barriers During Migraine. Front Comput Neurosci 2020; 14:4. [PMID: 32116618 PMCID: PMC7010722 DOI: 10.3389/fncom.2020.00004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/10/2020] [Indexed: 11/13/2022] Open
Abstract
Cerebrospinal fluid (CSF) and brain tissue sodium levels increase during migraine. However, little is known regarding the underlying mechanisms of sodium homeostasis disturbance in the brain during the onset and propagation of migraine. Exploring the cause of sodium dysregulation in the brain is important, since correction of the altered sodium homeostasis could potentially treat migraine. Under the hypothesis that disturbances in sodium transport mechanisms at the blood-CSF barrier (BCSFB) and/or the blood-brain barrier (BBB) are the underlying cause of the elevated CSF and brain tissue sodium levels during migraines, we developed a mechanistic, differential equation model of a rat's brain to compare the significance of the BCSFB and the BBB in controlling CSF and brain tissue sodium levels. The model includes the ventricular system, subarachnoid space, brain tissue and blood. Sodium transport from blood to CSF across the BCSFB, and from blood to brain tissue across the BBB were modeled by influx permeability coefficients PBCSFB and PBBB, respectively, while sodium movement from CSF into blood across the BCSFB, and from brain tissue to blood across the BBB were modeled by efflux permeability coefficients PBCSFB′ and PBBB′, respectively. We then performed a global sensitivity analysis to investigate the sensitivity of the ventricular CSF, subarachnoid CSF and brain tissue sodium concentrations to pathophysiological variations in PBCSFB, PBBB, PBCSFB′ and PBBB′. Our results show that the ventricular CSF sodium concentration is highly influenced by perturbations of PBCSFB, and to a much lesser extent by perturbations of PBCSFB′. Brain tissue and subarachnoid CSF sodium concentrations are more sensitive to pathophysiological variations of PBBB and PBBB′ than variations of PBCSFB and PBCSFB′ within 30 min of the onset of the perturbations. However, PBCSFB is the most sensitive model parameter, followed by PBBB and PBBB′, in controlling brain tissue and subarachnoid CSF sodium levels within 3 h of the perturbation onset.
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Affiliation(s)
- Hamed Ghaffari
- Department of Mechanical Engineering, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Samuel C Grant
- Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Tallahassee, FL, United States
| | - Linda R Petzold
- Department of Mechanical Engineering, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Michael G Harrington
- Neuroscience, Huntington Medical Research Institutes, Pasadena, CA, United States
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15
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Meyer MM, Schmidt A, Benrath J, Konstandin S, Pilz LR, Harrington MG, Budjan J, Meyer M, Schad LR, Schoenberg SO, Haneder S. Cerebral sodium ( 23Na) magnetic resonance imaging in patients with migraine - a case-control study. Eur Radiol 2019; 29:7055-7062. [PMID: 31264011 DOI: 10.1007/s00330-019-06299-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/21/2019] [Accepted: 06/03/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Evaluation of MRI-derived cerebral 23Na concentrations in patients with migraine in comparison with healthy controls. MATERIALS AND METHODS In this case-control study, 24 female migraine patients (mean age, 34 ± 11 years) were enrolled after evaluation of standardized questionnaires. Half (n = 12) of the cohort suffered from migraine, the other half was impaired by both migraine and tension-type headaches (TTH). The combined patient cohort was matched to 12 healthy female controls (mean age, 34 ± 11 years). All participants underwent a cerebral 23Na-magnetic resonance imaging examination at 3.0 T, which included a T1w MP-RAGE sequence and a 3D density-adapted, radial gradient echo sequence for 23Na imaging. Circular regions of interests were placed in predetermined anatomic regions: cerebrospinal fluid (CSF), gray and white matter, brain stem, and cerebellum. External 23Na reference phantoms were used to calculate the total 23Na tissue concentrations. Pearson's correlation, Kendall Tau, and Wilcoxon rank sum test were used for statistical analysis. RESULTS 23Na concentrations of all patients in the CSF were significantly higher than in healthy controls (p < 0.001). The CSF of both the migraine and mixed migraine/TTH group showed significantly increased sodium concentrations compared to the control group (p = 0.007 and p < 0.001). Within the patient cohort, a positive correlation between pain level and TSC in the CSF (r = 0.62) could be observed. CONCLUSION MRI-derived cerebral 23Na concentrations in the CSF of migraine patients were found to be statistically significantly higher than in healthy controls. KEY POINTS • Cerebral sodium MRI supports the theory of ionic imbalances and may aid in the challenging pathophysiologic understanding of migraine. • Case-control study shows significantly higher sodium concentrations in cerebrospinal fluid of migraineurs. • Cerebral sodium MRI may become a non-invasive imaging tool for drugs to modulate sodium, and hence migraine, on a molecular level, and influence patient management.
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Affiliation(s)
- Melissa M Meyer
- Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Alexander Schmidt
- Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Department of Diagnostic and Interventional Radiology, University of Würzburg, Würzburg, Germany
| | - Justus Benrath
- Clinic for Anaesthesiology and Operative Intensive Care, University of Heidelberg, Mannheim, Germany
| | | | - Lothar R Pilz
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Johannes Budjan
- Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Mathias Meyer
- Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Stefan Haneder
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
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16
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Gross NB, Abad N, Lichtstein D, Taron S, Aparicio L, Fonteh AN, Arakaki X, Cowan RP, Grant SC, Harrington MG. Endogenous Na+, K+-ATPase inhibitors and CSF [Na+] contribute to migraine formation. PLoS One 2019; 14:e0218041. [PMID: 31173612 PMCID: PMC6555523 DOI: 10.1371/journal.pone.0218041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 05/24/2019] [Indexed: 12/24/2022] Open
Abstract
There is strong evidence that neuronal hyper-excitability underlies migraine, and may or may not be preceded by cortical spreading depression. However, the mechanisms for cortical spreading depression and/or migraine are not established. Previous studies reported that cerebrospinal fluid (CSF) [Na+] is higher during migraine, and that higher extracellular [Na+] leads to hyper-excitability. We raise the hypothesis that altered choroid plexus Na+, K+-ATPase activity can cause both migraine phenomena: inhibition raises CSF [K+] and initiates cortical spreading depression, while activation raises CSF [Na+] and causes migraine. In this study, we examined levels of specific Na+, K+-ATPase inhibitors, endogenous ouabain-like compounds (EOLC), in CSF from migraineurs and controls. CSF EOLC levels were significantly lower during ictal migraine (0.4 nM +/- 0.09) than from either controls (1.8 nM +/- 0.4) or interictal migraineurs (3.1 nM +/- 1.9). Blood plasma EOLC levels were higher in migraineurs than controls, but did not differ between ictal and interictal states. In a Sprague-Dawley rat model of nitroglycerin-triggered central sensitization, we changed the concentrations of EOLC and CSF sodium, and measured aversive mechanical threshold (von Frey hairs), trigeminal nucleus caudalis activation (cFos), and CSF [Na+] (ultra-high field 23Na MRI). Animals were sensitized by three independent treatments: intraperitoneal nitroglycerin, immunodepleting EOLC from cerebral ventricles, or cerebroventricular infusion of higher CSF [Na+]. Conversely, nitroglycerin-triggered sensitization was prevented by either vascular or cerebroventricular delivery of the specific Na+, K+-ATPase inhibitor, ouabain. These results affirm our hypothesis that higher CSF [Na+] is linked to human migraine and to a rodent migraine model, and demonstrate that EOLC regulates them both. Our data suggest that altered choroid plexus Na+, K+-ATPase activity is a common source of these changes, and may be the initiating mechanism in migraine.
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Affiliation(s)
- Noah B. Gross
- Huntington Medical Research Institutes, Pasadena, California, United States of America
| | - Nastaren Abad
- Department of Chemical & Biomedical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, United States of America
- Center for Interdisciplinary Magnetic Resonance, National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, United States of America
| | - David Lichtstein
- Department of Medical Neurobiology, Institute for Medical Research, Israel-Canada, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shiri Taron
- Department of Medical Neurobiology, Institute for Medical Research, Israel-Canada, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lorena Aparicio
- Huntington Medical Research Institutes, Pasadena, California, United States of America
| | - Alfred N. Fonteh
- Huntington Medical Research Institutes, Pasadena, California, United States of America
| | - Xianghong Arakaki
- Huntington Medical Research Institutes, Pasadena, California, United States of America
| | - Robert P. Cowan
- Department of Neurology, Stanford University, Palo Alto, California, United States of America
| | - Samuel C. Grant
- Department of Chemical & Biomedical Engineering, FAMU-FSU College of Engineering, Florida State University, Tallahassee, Florida, United States of America
- Center for Interdisciplinary Magnetic Resonance, National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, United States of America
| | - Michael G. Harrington
- Huntington Medical Research Institutes, Pasadena, California, United States of America
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17
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Abad N, Rosenberg JT, Hike DC, Harrington MG, Grant SC. Dynamic sodium imaging at ultra-high field reveals progression in a preclinical migraine model. Pain 2018; 159:2058-2065. [PMID: 29905652 PMCID: PMC6150813 DOI: 10.1097/j.pain.0000000000001307] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Under the hypothesis that increased extracellular sodium induces sustained neuronal excitability with the onset and progression of migraine, this study evaluates dynamic in vivo Na fluxes in the brain of a preclinical rodent analogue of migraine. Ultra-high field Na magnetic resonance imaging (MRI) at 21.1 T has demonstrated potential to quantify sodium concentrations with good spatial and temporal resolution after the onset of central sensitization. Sprague-Dawley male rats with implanted intraperitoneal lines were studied by MRI before and after an in situ injection of 10 mg/kg of nitroglycerin (NTG) vs vehicle and saline controls. Slice-selective Na images were acquired using a multislice free induction decay-based chemical shift imaging sequence with resolution of 1.1 × 1.1 × 3 mm for a 9-minute acquisition. A total of 27 repeated scans were acquired over 1 hour of baseline scanning and longitudinally up to 3 hours after injection. Increases of Na MRI signal in the brainstem, extracerebral cerebrospinal fluid, and cisterna magna were evident almost immediately after NTG injection, gaining significance from controls in 36 minutes. The cerebellum and third ventricle also showed sustained trends of increased Na, with the former gaining significance at over 2 hours after NTG injection. The data provide evidence of an early change in sodium concentration, markedly in posterior fossa cerebrospinal fluid and brainstem regions. Further study of fluctuations of sodium concentration and their modulation with treatments could help understand the dynamic features of migraine, locate a putative migraine generator, and guide development of therapeutic measures to correct the disturbance of sodium homeostasis.
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Affiliation(s)
- Nastaren Abad
- Center for Interdisciplinary Magnetic Resonance, The National High Magnetic Field Laboratory, Florida State University, Tallahassee, FL, USA
- Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Tallahassee, FL, USA
| | - Jens T. Rosenberg
- Center for Interdisciplinary Magnetic Resonance, The National High Magnetic Field Laboratory, Florida State University, Tallahassee, FL, USA
| | - David C. Hike
- Center for Interdisciplinary Magnetic Resonance, The National High Magnetic Field Laboratory, Florida State University, Tallahassee, FL, USA
- Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Tallahassee, FL, USA
| | - Michael G. Harrington
- Molecular Neurology Program, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Samuel C. Grant
- Center for Interdisciplinary Magnetic Resonance, The National High Magnetic Field Laboratory, Florida State University, Tallahassee, FL, USA
- Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Tallahassee, FL, USA
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18
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Hassel B, Mariussen E, Idland AV, Dahl GT, Ræder J, Frihagen F, Berg JP, Chaudhry FA, Wyller TB, Watne LO. CSF sodium at toxic levels precedes delirium in hip fracture patients. Neurotoxicology 2018; 69:11-16. [PMID: 30149051 DOI: 10.1016/j.neuro.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
Abstract
Delirium is an acute state of confusion and a fluctuating level of consciousness. It is precipitated by physical illness or trauma, such as pneumonia, heart infarction, or hip fracture. Delirium is common among elderly hospitalized patients, and as many as 50% of hip fracture patients may develop delirium. Delirium may precipitate dementia, but recent studies indicate that delirium is caused by unknown neurotoxic mechanisms that are different from those that are associated with dementia. Experimental studies have shown that high extracellular levels of sodium are neurotoxic. We sampled lumbar cerebrospinal fluid (CSF) from hip fracture patients during hip surgery and analyzed metal ions that influence neuronal function. Eight patients who developed delirium after surgery had 21% higher CSF sodium than 17 patients who did not develop delirium (median value 175 mmol/L; range 154-188, vs. 145 mmol/L (112-204; p < 0.008) or 39 patients who underwent elective surgery under spinal anesthesia without developing delirium (145 mmol/L; 140-149; p = 0.0004). Seven patients who had developed delirium before CSF sampling had a median CSF sodium of 150 mmol/L (144-185; p = 0.3). CSF potassium was also 21% higher in patients who developed delirium (p = 0.024), but remained within the physiological range. Serum sodium and potassium were normal in all patient groups. This study, on a small sample of patients, confirms the neurotoxic potential and clinical importance of high extracellular levels of sodium in the brain. High CSF sodium would likely affect cerebral function and could precipitate delirium; further, it could interact with dementia-specific mechanisms to precipitate dementia development.
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Affiliation(s)
- Bjørnar Hassel
- Department of Neurohabilitation and Complex Neurology, Oslo University Hospital, University of Oslo, Oslo, Norway; Norwegian Defence Research Establishment (FFI), Kjeller, Norway.
| | - Espen Mariussen
- Norwegian Defence Research Establishment (FFI), Kjeller, Norway; Norwegian Institute for Air Research (NILU), Kjeller, Norway
| | - Ane-Victoria Idland
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gry T Dahl
- Department of Anesthesiology, Diakonhjemmet Hospital, Oslo, Norway
| | - Johan Ræder
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
| | - Frede Frihagen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Jens Petter Berg
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | | | - Torgeir B Wyller
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Leiv O Watne
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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19
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Abad N, Rosenberg JT, Roussel T, Grice DC, Harrington MG, Grant SC. Metabolic assessment of a migraine model using relaxation-enhanced 1 H spectroscopy at ultrahigh field. Magn Reson Med 2018; 79:1266-1275. [PMID: 28921630 PMCID: PMC5775911 DOI: 10.1002/mrm.26811] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 04/10/2017] [Accepted: 06/02/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE This study evaluates biochemical imbalances in a rat model that reflects dysfunctional pathways in migraine. The high sensitivity and spectral dispersion available to 1 H MRS at 21.1 T expands metabolic profiling in this migraine model to include lactate (Lac), taurine (Tau), aspartate, and Gly-a mixture of glycine, glutamine, and glutamate. METHODS Sprague-Dawley male rats were administered in situ an intraperitoneal injection of nitroglycerin (NTG) to induce the migraine analogue or saline as a control. A selective relaxation-enhanced MR spectroscopy sequence was used to target upfield metabolites from a 4-mm3 voxel for 2.5 h after injection. RESULTS Significant increases were evident for Lac as early as 10 min after NTG injection, peaking over 50% compared with baseline and control (normalized Lac/N-acetyl aspartate with NTG = 1.54 ± 0.65 versus with saline = 0.99 ± 0.08). Tau decreased progressively in controls over 2 h after injection, but remained elevated with NTG, peaking at 105 min after injection (normalized Tau/N-acetyl aspartate with NTG = 1.10 ± 0.18 versus with saline = 0.85 ± 0.14). Total creatine under NTG showed significant decreases with time and compared with saline; Gly demonstrated temporal increases for NTG. CONCLUSIONS These changes indicate an altered metabolic profile in the migraine analogue consistent with early changes in neural activity and/or vasodilation consistent with progressively enhanced neuroprotection and osmoregulation. Magn Reson Med 79:1266-1275, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Nastaren Abad
- Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Tallahassee, Florida, USA
- The National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, USA
| | - Jens T Rosenberg
- The National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, USA
| | - Tangi Roussel
- Department of Chemical Physics, Weizmann Institute Science, Rehovot, Israel
| | - Dillon C Grice
- Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Tallahassee, Florida, USA
| | - Michael G Harrington
- Molecular Neurology Program, Huntington Medical Research Institutes, Pasadena, California, USA
| | - Samuel C Grant
- Department of Chemical and Biomedical Engineering, FAMU-FSU College of Engineering, Tallahassee, Florida, USA
- The National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, USA
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20
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Gilles A, Nagel AM, Madelin G. Multipulse sodium magnetic resonance imaging for multicompartment quantification: Proof-of-concept. Sci Rep 2017; 7:17435. [PMID: 29234043 PMCID: PMC5727256 DOI: 10.1038/s41598-017-17582-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/27/2017] [Indexed: 12/18/2022] Open
Abstract
We present a feasibility study of sodium quantification in a multicompartment model of the brain using sodium (23Na) magnetic resonance imaging. The proposed method is based on a multipulse sequence acquisition and simulation at 7 T, which allows to differentiate the 23Na signals emanating from three compartments in human brain in vivo: intracellular (compartment 1), extracellular (compartment 2), and cerebrospinal fluid (compartment 3). The intracellular sodium concentration C1 and the volume fractions α1, α2, and α3 of all respective three brain compartments can be estimated. Simulations of the sodium spin 3/2 dynamics during a 15-pulse sequence were used to optimize the acquisition sequence by minimizing the correlation between the signal evolutions from the three compartments. The method was first tested on a three-compartment phantom as proof-of-concept. Average values of the 23Na quantifications in four healthy volunteer brains were α1 = 0.54 ± 0.01, α2 = 0.23 ± 0.01, α3 = 1.03 ± 0.01, and C1 = 23 ± 3 mM, which are comparable to the expected physiological values \documentclass[12pt]{minimal}
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\begin{document}$${{\boldsymbol{C}}}_{{\bf{1}}}^{{\boldsymbol{theory}}}$$\end{document}C1theory ∼ 10–30 mM. The proposed method may allow a quantitative assessment of the metabolic role of sodium ions in cellular processes and their malfunctions in brain in vivo.
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Affiliation(s)
- Alina Gilles
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, 10016, USA.,Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Guillaume Madelin
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, 10016, USA.
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Martínez-Valverde T, Sánchez-Guerrero A, Vidal-Jorge M, Torné R, Castro L, Gandara D, Munar F, Poca MA, Sahuquillo J. Characterization of the Ionic Profile of the Extracellular Space of the Injured and Ischemic Brain: A Microdialysis Study. J Neurotrauma 2017; 34:74-85. [DOI: 10.1089/neu.2015.4334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Tamara Martínez-Valverde
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Angela Sánchez-Guerrero
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Marian Vidal-Jorge
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Ramon Torné
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Universidad Autònoma de Barcelona, Barcelona, Spain
- Department of Neurosurgery, Vall d'Hebron University Hospital, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Lidia Castro
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Dario Gandara
- Department of Neurosurgery, Vall d'Hebron University Hospital, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Francisca Munar
- Department of Anesthesiology, Vall d'Hebron University Hospital, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Maria-Antonia Poca
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Universidad Autònoma de Barcelona, Barcelona, Spain
- Department of Neurosurgery, Vall d'Hebron University Hospital, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Juan Sahuquillo
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Universidad Autònoma de Barcelona, Barcelona, Spain
- Department of Neurosurgery, Vall d'Hebron University Hospital, Universidad Autònoma de Barcelona, Barcelona, Spain
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22
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Martin VT, Vij B. Diet and Headache: Part 2. Headache 2016; 56:1553-1562. [DOI: 10.1111/head.12952] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 08/31/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Vincent T. Martin
- Department of Internal Medicine; University of Cincinnati College of Medicine; Cincinnati OH USA
| | - Brinder Vij
- Department of Neurology; University of Cincinnati College of Medicine; Cincinnati OH USA
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23
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van Dongen RM, Zielman R, Noga M, Dekkers OM, Hankemeier T, van den Maagdenberg AM, Terwindt GM, Ferrari MD. Migraine biomarkers in cerebrospinal fluid: A systematic review and meta-analysis. Cephalalgia 2016; 37:49-63. [PMID: 26888294 DOI: 10.1177/0333102415625614] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To perform a meta-analysis of migraine biomarkers in cerebrospinal fluid (CSF) and of corresponding blood concentrations. Methods We conducted a systematic search for studies that measured biochemical compounds in CSF of chronic or episodic migraineurs and non-headache controls. Subsequent searches retrieved studies with blood measurements of selected CSF biomarkers. If a compound was assessed in three or more studies, results were pooled in a meta-analysis with standardised mean differences (SMD) as effect measures. Results Sixty-two compounds were measured in 40 CSF studies. Most important results include: increased glutamate (five studies, SMD 2.22, 95% CI: 1.30, 3.13), calcitonin gene-related peptide (CGRP) (three studies, SMD: 3.80, 95% CI: 3.19, 4.41) and nerve growth factor (NGF) (three studies, SMD: 6.47, 95% CI: 5.55, 7.39) in chronic migraine patients and decreased β-endorphin (β-EP) in both chronic (four studies, SMD: -1.37, 95% CI: -1.80, -0.94) and interictal episodic migraine patients (three studies, SMD: -1.12, 95% CI: -1.65, -0.58). In blood, glutamate (interictal) and CGRP (chronic, interictal and ictal) were increased and β-EP (chronic, interictal and ictal) was decreased. Conclusions Glutamate, β-EP, CGRP and NGF concentrations are altered in CSF and, except for NGF, also in blood of migraineurs. Future research should focus on the pathophysiological roles of these compounds in migraine.
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Affiliation(s)
- Robin M van Dongen
- 1 Department of Neurology, Leiden University Medical Centre, the Netherlands
| | - Ronald Zielman
- 1 Department of Neurology, Leiden University Medical Centre, the Netherlands
| | - Marek Noga
- 2 Division of Analytical Biosciences, Leiden Academic Centre for Drug Research, the Netherlands
| | - Olaf M Dekkers
- 3 Department of Clinical Epidemiology, Leiden University Medical Centre, the Netherlands.,4 Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - Thomas Hankemeier
- 2 Division of Analytical Biosciences, Leiden Academic Centre for Drug Research, the Netherlands
| | - Arn Mjm van den Maagdenberg
- 1 Department of Neurology, Leiden University Medical Centre, the Netherlands.,5 Department of Human Genetics, Leiden University Medical Centre, the Netherlands
| | - Gisela M Terwindt
- 1 Department of Neurology, Leiden University Medical Centre, the Netherlands
| | - Michel D Ferrari
- 1 Department of Neurology, Leiden University Medical Centre, the Netherlands
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Loewendorf AI, Matynia A, Saribekyan H, Gross N, Csete M, Harrington M. Roads Less Traveled: Sexual Dimorphism and Mast Cell Contributions to Migraine Pathology. Front Immunol 2016; 7:140. [PMID: 27148260 PMCID: PMC4836167 DOI: 10.3389/fimmu.2016.00140] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/31/2016] [Indexed: 12/30/2022] Open
Abstract
Migraine is a common, little understood, and debilitating disease. It is much more prominent in women than in men (~2/3 are women) but the reasons for female preponderance are not clear. Migraineurs frequently experience severe comorbidities, such as allergies, depression, irritable bowel syndrome, and others; many of the comorbidities are more common in females. Current treatments for migraine are not gender specific, and rarely are migraine and its comorbidities considered and treated by the same specialist. Thus, migraine treatments represent a huge unmet medical need, which will only be addressed with greater understanding of its underlying pathophysiology. We discuss the current knowledge about sex differences in migraine and its comorbidities, and focus on the potential role of mast cells (MCs) in both. Sex-based differences in pain recognition and drug responses, fluid balance, and the blood–brain barrier are recognized but their impact on migraine is not well studied. Furthermore, MCs are well recognized for their prominent role in allergies but much less is known about their contributions to pain pathways in general and migraine specifically. MC-neuron bidirectional communication uniquely positions these cells as potential initiators and/or perpetuators of pain. MCs can secrete nociceptor sensitizing and activating agents, such as serotonin, prostaglandins, histamine, and proteolytic enzymes that can also activate the pain-mediating transient receptor potential vanilloid channels. MCs express receptors for both estrogen and progesterone that induce degranulation upon binding. Furthermore, environmental estrogens, such as Bisphenol A, activate MCs in preclinical models but their impact on pain pathways or migraine is understudied. We hope that this discussion will encourage scientists and physicians alike to bridge the knowledge gaps linking sex, MCs, and migraine to develop better, more comprehensive treatments for migraine patients.
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Affiliation(s)
| | - Anna Matynia
- Department of Ophthalmology, Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA; Brain Research Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Noah Gross
- Huntington Medical Research Institutes , Pasadena, CA , USA
| | - Marie Csete
- Huntington Medical Research Institutes , Pasadena, CA , USA
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25
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Pogoda JM, Gross NB, Arakaki X, Fonteh AN, Cowan RP, Harrington MG. Severe Headache or Migraine History is Inversely Correlated With Dietary Sodium Intake: NHANES 1999-2004. Headache 2016; 56:688-98. [PMID: 27016121 PMCID: PMC4836999 DOI: 10.1111/head.12792] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective We investigated whether dietary sodium intake from respondents of a national cross‐sectional nutritional study differed by history of migraine or severe headaches. Background Several lines of evidence support a disruption of sodium homeostasis in migraine. Design Our analysis population was 8819 adults in the 1999–2004 National Health and Nutrition Examination Survey (NHANES) with reliable data on diet and headache history. We classified respondents who reported a history of migraine or severe headaches as having probable history of migraine. To reduce the diagnostic conflict from medication overuse headache, we excluded respondents who reported taking analgesic medications. Dietary sodium intake was measured using validated estimates of self‐reported total grams of daily sodium consumption and was analyzed as the residual value from the linear regression of total grams of sodium on total calories. Multivariable logistic regression that accounted for the stratified, multistage probability cluster sampling design of NHANES was used to analyze the relationship between migraine and dietary sodium. Results Odds of probable migraine history decreased with increasing dietary sodium intake (odds ratio = 0.93, 95% confidence interval = 0.87, 1.00, P = .0455). This relationship was maintained after adjusting for age, sex, and body mass index (BMI) with slightly reduced significance (P = .0505). In women, this inverse relationship was limited to those with lower BMI (P = .007), while in men the relationship did not differ by BMI. We likely excluded some migraineurs by omitting frequent analgesic users; however, a sensitivity analysis suggested little effect from this exclusion. Conclusions This study is the first evidence of an inverse relationship between migraine and dietary sodium intake. These results are consistent with altered sodium homeostasis in migraine and our hypothesis that dietary sodium may affect brain extracellular fluid sodium concentrations and neuronal excitability.
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Affiliation(s)
- Janice M Pogoda
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Noah B Gross
- Molecular Neurology Program, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Xianghong Arakaki
- Molecular Neurology Program, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Alfred N Fonteh
- Molecular Neurology Program, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Robert P Cowan
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael G Harrington
- Molecular Neurology Program, Huntington Medical Research Institutes, Pasadena, CA, USA
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26
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Gupta SN, Gupta VS, Fields DM. Spectrum of complicated migraine in children: A common profile in aid to clinical diagnosis. World J Clin Pediatr 2015; 4:1-12. [PMID: 25664241 PMCID: PMC4318797 DOI: 10.5409/wjcp.v4.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/06/2014] [Accepted: 12/17/2014] [Indexed: 02/06/2023] Open
Abstract
Complicated migraine encompasses several individual clinical syndromes of migraine. Such a syndrome in children frequently presents with various neurological symptoms in the Emergency Department. An acute presentation in the absence of headache presents a diagnostic challenge. A delay in diagnosis and treatment may have medicolegal implication. To date, there are no reports of a common clinical profile proposed in making a clinical diagnosis for the complicated migraine. In this clinical review, we propose and describe: (1) A common clinical profile in aid to clinical diagnosis for spectrum of complicated migraine; (2) How it can be used in differentiating complicated migraine from migraine without aura, migraine with aura, and seizure; (3) We discuss the status of complicated migraine in the International Headache Society classification 2013; and (4) In addition, a common treatment strategy for the spectrum of migraine has been described. To diagnose complicated migraine clinically, it is imperative to adhere with the proposed profile. This will optimize the use of investigation and will also avoid a legal implication of delay in their management. The proposed common clinical profile is incongruent with the International Headache Society 2013. Future classification should minimize the dissociation from clinically encountered syndromes and coin a single word to address collectively this subtype of migraine with an acute presentation of a common clinical profile.
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Niazi AK, Andelova M, Sprenger T. Is the migrainous brain normal outside of acute attacks? Lessons learned from psychophysical, neurochemical and functional neuroimaging studies. Expert Rev Neurother 2014; 13:1061-7. [PMID: 24053346 DOI: 10.1586/14737175.2013.835587] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Migraine is a largely inherited disorder of the brain with recurrent head pain attacks. There is an increasing awareness, however, that the manifestation of migrainous biology is not restricted to such acute head pain attacks, but that migraine is rather a disorder with a continuous complex and broad sensory processing dysfunction in which normal sensory stimuli (somatosensory, visual, auditory and olfactory) are misinterpreted by the brain. This dysfunction is most prominent during attacks, but there are more and more evidences that the processing and perception of stimuli is abnormal also outside of attacks to a varying degree. In this topical review, we will summarize and discuss the current clinical, neurochemical and functional neuroimaging literature on this paradigm shift from a strictly episodic head pain disorder to migraine as a more general dysfunction of sensory processing.
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Durham P, Papapetropoulos S. Biomarkers associated with migraine and their potential role in migraine management. Headache 2013; 53:1262-77. [PMID: 23848170 DOI: 10.1111/head.12174] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The focus of this review is to review potential diagnostic and therapeutic biomarkers associated with migraine. BACKGROUND Migraine headache is a common disease that affects millions of individuals worldwide. Although well-accepted diagnostic criteria exist for migraine, it is still a complex disorder that remains both underdiagnosed and misdiagnosed. The causes of migraine are likely a mix of genetic, epigenetic, and environmental factors that, together with the individual's life history, translate into the observed clinical heterogeneity. Inherent clinical heterogeneity is an obstacle in developing more effective treatments. The lack of appropriate biomarkers is also an impediment to developing more effective therapeutic/preventive approaches. Ultimately, biomarkers may facilitate the goal of individualized medicine by enabling clinicians to more accurately diagnose and treat migraine and other types of headache. METHODS A comprehensive review was conducted of PubMed citations containing the key word "marker" OR "biomarker" combined with "migraine" OR "headache." Other key words included "serum," "saliva," "cerebrospinal fluid," "genes," "blood," and "inflammation." The only restriction was English-language publication. The abstracts of all articles meeting these criteria were reviewed, and full text was retrieved and examined for relevant references. RESULTS Data from human studies have begun to identify genetic mutations/polymorphisms and altered levels of specific proinflammatory and neuromodulatory molecules that strongly correlate with migraine as well as symptom severity. Results from a smaller number of studies have identified parameters, such as the neuropeptide calcitonin gene-related peptide (CGRP), which are significantly associated with response to specific treatments for acute migraine attacks and prophylaxis. Epigenetic mechanisms may also be involved in the development of migraine, and understanding environmentally induced genetic changes associated with this disease may eventually guide the development of therapies capable of reversing these pathophysiological changes in gene function. CONCLUSIONS The understanding of the etiology of migraine is incomplete. Although the identification and validation of biomarkers has greatly advanced diagnostic precision and measures of therapeutic efficacy in other diseases, there are no currently accepted biomarkers for chronic or episodic migraine. However, the continued investigation and identification of genetic, epigenetic, and molecular biomarkers is likely to facilitate the goal of individualizing medicine by enabling clinicians to more accurately diagnose and treat migraine and other headache disorders.
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Affiliation(s)
- Paul Durham
- Jordan Valley Innovation Center - Center for Biomedical and Life Sciences, Missouri State University, Springfield, MO, USA
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29
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Arakaki X, McCleary P, Techy M, Chiang J, Kuo L, Fonteh AN, Armstrong B, Levy D, Harrington MG. Na,K-ATPase alpha isoforms at the blood-cerebrospinal fluid-trigeminal nerve and blood-retina interfaces in the rat. Fluids Barriers CNS 2013; 10:14. [PMID: 23497725 PMCID: PMC3636111 DOI: 10.1186/2045-8118-10-14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 03/07/2013] [Indexed: 01/12/2023] Open
Abstract
Background Cerebrospinal fluid (CSF) sodium concentration increases during migraine attacks, and both CSF and vitreous humor sodium increase in the rat migraine model. The Na,K-ATPase is a probable source of these sodium fluxes. Since Na,K-ATPase isoforms have different locations and physiological roles, our objective was to establish which alpha isoforms are present at sites where sodium homeostasis is disrupted. Methods Specific Na,K-ATPase alpha isoforms were identified in rat tissues by immunohistochemistry at the blood-CSF barrier at the choroid plexus, at the blood-CSF-trigeminal barrier at the meninges, at the blood-retina barrier, and at the blood-aqueous barrier at the ciliary body. Calcitonin gene-related peptide (CGRP), occludin, or von Willibrand factor (vWF) were co-localized with Na,K-ATPase to identify trigeminal nociceptor fibers, tight junctions, and capillary endothelial cells respectively. Results The Na,K-ATPase alpha-2 isoform is located on capillaries and intensely at nociceptive trigeminal nerve fibers at the meningeal blood-CSF-trigeminal barrier. Alpha-1 and −3 are lightly expressed on the trigeminal nerve fibers but not at capillaries. Alpha-2 is expressed at the blood-retina barriers and, with alpha-1, at the ciliary body blood aqueous barrier. Intense apical membrane alpha-1 was associated with moderate cytoplasmic alpha-2 expression at the choroid plexus blood-CSF barrier. Conclusion Na,K-ATPase alpha isoforms are present at the meningeal, choroid plexus, and retinal barriers. Alpha-2 predominates at the capillary endothelial cells in the meninges and retinal ganglion cell layer.
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Affiliation(s)
- Xianghong Arakaki
- Molecular Neurology Program, Huntington Medical Research Institutes, 99 N, El Molino Avenue, Pasadena, CA, 91101, USA.
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A perspective from magnetic resonance imaging findings of the inner ear: Relationships among cerebrospinal, ocular and inner ear fluids. Auris Nasus Larynx 2012; 39:345-55. [DOI: 10.1016/j.anl.2011.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 05/06/2011] [Accepted: 05/17/2011] [Indexed: 02/06/2023]
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Harrington MG, Chekmenev EY, Schepkin V, Fonteh AN, Arakaki X. Sodium MRI in a rat migraine model and a NEURON simulation study support a role for sodium in migraine. Cephalalgia 2011; 31:1254-65. [PMID: 21816771 DOI: 10.1177/0333102411408360] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Increased lumbar cerebrospinal fluid (CSF) sodium has been reported during migraine. We used ultra-high field MRI to investigate cranial sodium in a rat migraine model, and simulated the effects of extracellular sodium on neuronal excitability. METHODS Behavioral changes in the nitroglycerin (NTG) rat migraine model were determined from von Frey hair withdrawal response and photography. Central sensitization was measured by counting cFos-immunoreactive cells in the trigeminal nucleus caudalis (TNC). Sodium was quantified in vivo by ultra-high field sodium MRI at 21 Tesla. Effects of extracellular sodium on neuronal excitability were modeled using NEURON software. RESULTS NTG decreased von Frey withdrawal threshold (p=0.0003), decreased eyelid vertical height:width ratio (p<0.0001), increased TNC cFos stain (p<0.0001), and increased sodium between 7.5 and 17% in brain, intracranial CSF, and vitreous humor (p<0.05). Simulated neurons exposed to higher sodium have more frequent and earlier spontaneous action potentials, and corresponding earlier sodium and potassium currents. CONCLUSIONS In the rat migraine model, sodium rises to levels that increase neuronal excitability. We propose that rising sodium in CSF surrounding trigeminal nociceptors increases their excitability and causes pain and that rising sodium in vitreous humor increases retinal neuronal excitability and causes photosensitivity.
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Affiliation(s)
- Michael G Harrington
- Molecular Neurology Program, Huntington Medical Research Institutes, 99 North El Molino Avenue, Pasadena, CA 91101, USA.
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Arakaki X, Foster H, Su L, Do H, Wain AJ, Fonteh AN, Zhou F, Harrington MG. Extracellular sodium modulates the excitability of cultured hippocampal pyramidal cells. Brain Res 2011; 1401:85-94. [PMID: 21679932 DOI: 10.1016/j.brainres.2011.05.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 05/01/2011] [Accepted: 05/15/2011] [Indexed: 02/08/2023]
Abstract
Recent studies demonstrated a photophobia mechanism with modulation of nociceptive, cortico-thalamic neurons by retinal ganglion cell projections; however, little is known about how their neuronal homeostasis is disrupted. Since we have found that lumbar cerebrospinal fluid (CSF) sodium increases during migraine and that cranial sodium increases in a rat migraine model, the purpose of this study was to examine the effects of extracellular sodium ([Na(+)](o)) on the intrinsic excitability of hippocampal pyramidal neurons. We monitored excitability by whole cell patch using a multiplex micropipette with a common outlet to change artificial CSF (ACSF) [Na(+)](o) at cultured neurons accurately (SD<7 mM) and rapidly (<5s) as determined by a sodium-selective micro-electrode of the same size and at the same location as a neuronal soma. Changing [Na(+)](o) in ACSF from 100 to 160 mM, choline-balanced at 310-320 mOsm, increased the action potential (AP) amplitude, decreased AP width, and augmented firing rate by 28%. These effects were reversed on returning the ACSF [Na(+)](o) to 100mM. Testing up to 180 mM [Na(+)](o) required ACSF with higher osmolarity (345-355 mOsm), at which the firing rate increased by 36% between 100 and 180 mM [Na(+)](o), with higher amplitude and narrower APs. In voltage clamp mode, the sodium and potassium currents increased significantly at higher [Na(+)](o). These results demonstrate that fluctuations in [Na(+)](o) modulate neuronal excitability by a sodium current mechanism and that excessively altered neuronal excitability may contribute to hypersensitivity symptoms.
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Affiliation(s)
- Xianghong Arakaki
- Molecular Neurology Program, Huntington Medical Research Institutes, 99 North El Molino Avenue, Pasadena, CA 91101, USA
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Harrington MG, Fonteh AN, Arakaki X, Cowan RP, Ecke LE, Foster H, Hühmer AF, Biringer RG. Capillary endothelial Na(+), K(+), ATPase transporter homeostasis and a new theory for migraine pathophysiology. Headache 2010; 50:459-78. [PMID: 19845787 PMCID: PMC8020446 DOI: 10.1111/j.1526-4610.2009.01551.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cerebrospinal fluid sodium concentration ([Na(+)](csf)) increases during migraine, but the cause of the increase is not known. OBJECTIVE Analyze biochemical pathways that influence [Na(+)](csf) to identify mechanisms that are consistent with migraine. METHOD We reviewed sodium physiology and biochemistry publications for links to migraine and pain. RESULTS Increased capillary endothelial cell (CEC) Na(+), K(+), -ATPase transporter (NKAT) activity is probably the primary cause of increased [Na(+)](csf). Physiological fluctuations of all NKAT regulators in blood, many known to be involved in migraine, are monitored by receptors on the luminal wall of brain CECs; signals are then transduced to their abluminal NKATs that alter brain extracellular sodium ([Na(+)](e)) and potassium ([K(+)](e)). CONCLUSIONS We propose a theoretical mechanism for aura and migraine when NKAT activity shifts outside normal limits: (1) CEC NKAT activity below a lower limit increases [K(+)](e), facilitates cortical spreading depression, and causes aura; (2) CEC NKAT activity above an upper limit elevates [Na(+)](e), increases neuronal excitability, and causes migraine; (3) migraine-without-aura may arise from CEC NKAT over-activity without requiring a prior decrease in activity and its consequent spreading depression; (4) migraine triggers disturb, and treatments improve, CEC NKAT homeostasis; (5) CEC NKAT-induced regulation of neural and vasomotor excitability coordinates vascular and neuronal activities, and includes occasional pathology from CEC NKAT-induced apoptosis or cerebral infarction.
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Affiliation(s)
- Michael G Harrington
- Huntington Medical Research Institutes - Molecular Neurology, Pasadena, CA 91101, USA
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Harrington MG, Salomon RM, Pogoda JM, Oborina E, Okey N, Johnson B, Schmidt D, Fonteh AN, Dalleska NF. Cerebrospinal fluid sodium rhythms. Cerebrospinal Fluid Res 2010; 7:3. [PMID: 20205754 PMCID: PMC2822736 DOI: 10.1186/1743-8454-7-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 01/20/2010] [Indexed: 11/23/2022] Open
Abstract
Background Cerebrospinal fluid (CSF) sodium levels have been reported to rise during episodic migraine. Since migraine frequently starts in early morning or late afternoon, we hypothesized that natural sodium chronobiology may predispose susceptible persons when extracellular CSF sodium increases. Since no mammalian brain sodium rhythms are known, we designed a study of healthy humans to test if cation rhythms exist in CSF. Methods Lumbar CSF was collected every ten minutes at 0.1 mL/min for 24 h from six healthy participants. CSF sodium and potassium concentrations were measured by ion chromatography, total protein by fluorescent spectrometry, and osmolarity by freezing point depression. We analyzed cation and protein distributions over the 24 h period and spectral and permutation tests to identify significant rhythms. We applied the False Discovery Rate method to adjust significance levels for multiple tests and Spearman correlations to compare sodium fluctuations with potassium, protein, and osmolarity. Results The distribution of sodium varied much more than potassium, and there were statistically significant rhythms at 12 and 1.65 h periods. Curve fitting to the average time course of the mean sodium of all six subjects revealed the lowest sodium levels at 03.20 h and highest at 08.00 h, a second nadir at 09.50 h and a second peak at 18.10 h. Sodium levels were not correlated with potassium or protein concentration, or with osmolarity. Conclusion These CSF rhythms are the first reports of sodium chronobiology in the human nervous system. The results are consistent with our hypothesis that rising levels of extracellular sodium may contribute to the timing of migraine onset. The physiological importance of sodium in the nervous system suggests that these rhythms may have additional repercussions on ultradian functions.
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Haensch CA. Cerebrospinal Fluid Magnesium Level in Different Neurological Disorders. ACTA ACUST UNITED AC 2010. [DOI: 10.4236/nm.2010.12009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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