Migraine with urticaria

Choroidal thickness and retinal nerve fiber layer analysis in chronic spontaneous urticaria

Aim: In this study, we investigated the effects of chronic spontaneous urticaria on the choroid and retinal nerve fiber layer. Material and Method: The patient group consisted of newly diagnosed 54 chronic spontaneous urticaria (CSU ) patient and the control group consisted of 54 healthy volunteer. Choroidal and retinal nerve fiber layer (RNFL) thickness measurements were performed with Cirrus HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA, USA) 30 minutes after pupil dilation with 0,5% tropicamide. Results: In the patient group, nasal choroidal thickness (NCT) was 290.11±43.16 μm, subfoveal choroidal thickness (SFCT) was 339.17±37.709 μm, temporal choroidal thickness (TCT) was 296.00±42.859 μm, mean choroidal thickness (MCT) was 308.33±35.923 μm and RNFL thickness was 91.11±7.393 μm. NCT was 248.42±35,742 μm, SFCT 276.56±40.04 μm, TCT 253.69±37.384 μm, MCT 259.50±32,986 μm and RNFL thickness 92.19±8.719 μm in the control group. When we examine the p value, it is seen that both groups are similar to each other in terms of RNFL thickness (p=0.326), while there is a significant thickening in all choroidal regions of patients with CSU, including NCT, SFCT, TCT, MCT (p=0.000, p=0.000, p=0.000, p=0.000, respectively). Conclusion: The choroid is affected in CSU and choroidal thickness can be a noninvasive method that can be used in diagnosis CSU. However, studies of longer disease durations may provide more illuminating information about CSU and choroid and RNFL.

Is chronic urticaria more than skin deep?

Chronic urticaria is a disease characterized by the appearance of weals, angioedema or both longer than 6 weeks. Degranulation of cutaneous or submucosal mast cells leads to release of mediators including histamine resulting in redness, swelling and itch. Because mast cells are widely distributed throughout the body, the question is why they are not activated systemically or does systemic activation occur without overt end organ dysfunction? We have conducted an exploratory literature search for reports that have evidence of organ-specific dysfunction in chronic urticaria that might justify prospective observational studies. This search revealed some evidence of systemic effects of chronic urticaria in cardiac, respiratory, gastrointestinal, central nervous and musculo-skeletal systems. The relevance of these findings needs to be further determined. However, they justify prospective studies in larger numbers of patients and at different stages of disease activity.

Ten years of follow-up in a large family with familial hemiplegic migraine type 1: Clinical course and implications for treatment

Background Familial hemiplegic migraine (FHM) is a rare, genetic form of migraine with aura. The severity of the aura imposes an effective prophylaxis that is currently based on standard anti-migraine drugs. To this concern, only short-term reports are currently available. Methods Eight patients from a multigenerational FHM type 1 family harbouring a T666M mutation in the CACNA1A gene were referred to our ataxia outpatient clinic. Medical history, general and neurological examination as well as therapeutic approaches were recorded regularly on a routine basis for an average period of 13 years (range 9-15 years). Brain imaging studies and EEG data were also collected. Results Our long-term follow-up revealed that ictal manifestations, which usually improve after the adolescence, may reoccur later in the adulthood. Permanent neurological signs as assessed by means of clinical evaluation as well as follow-up MRIs, EEGs and neuropsychological testing remained stable. Interval therapy with non-selective calcium antagonists reduced the burden of migraine attacks and was well tolerated in the long term.

Allergy: a systemic disease? The HUNT and Young-HUNT study, Norway

A systemic nature of allergic diseases has been hypothesized. As part of this discussion, we studied if adolescent allergic wheeze and increasing combinations of allergic organ involvements (lung, nose and skin) would also increase the reporting of other health problems (headache, muscle pain and abdominal pain). In addition, we studied if parental asthma was associated with adolescent clustering of allergic expressions and if parental asthma with additional health problems (headache or muscle pain) was associated with adolescent reporting allergy in combination with headache, muscle pain and abdominal pain. Adolescents 13-19 yr (n = 8817, 89%) participated in the Young-HUNT study, Norway, 1995-97. Parental data on asthma were eligible in n = 5620. Health and lifestyle were measured by questionnaires and interviews. Associations with additional health problems were significantly strengthened with combinations of wheeze and other allergic expressions. Odds Ratio for associations 'wheeze only', 'wheeze and rhinitis' and 'wheeze, rhinitis and eczema' were for headache 2.1, 3.4 and 3.7; for muscle pain 2.8, 3.2 and 4.9; for abdominal pain 3.6, 4.0 and 4.9. All p for trend were <0.010. Similar results were obtained when studying allergic wheeze; p for trend <0.001. Parental asthma was associated with clustering of adolescent allergic expressions, and parental asthma with headache or muscle pain was significantly associated with reported allergy combined with similar health problems in their offspring. The results indicate that allergy may be expressed beyond organs commonly viewed as part of an allergic disease, and hence may support a hypothesis of a systemic nature of allergic diseases.