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Saini L, Gunasekaran PK, Tiwari S, Choudhary B, Manjunathan S, Kumar A. Familial hemiplegic migraine in Indian children-a tertiary center experience. J Trop Pediatr 2024; 70:fmae008. [PMID: 38580379 DOI: 10.1093/tropej/fmae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
Familial hemiplegic migraine (FHM), an autosomal dominant subtype of hemiplegic migraine, is a channelopathy presenting with severe headache, visual field defect, paresthesia, unilateral motor deficit, encephalopathy, seizures and aphasia. This cross-sectional study was conducted over 10 months in children aged 1-18 years suspected of hemiplegic migraine at a tertiary care pediatric hospital. Fourteen children were screened and five children with genetically confirmed FHM were included. The symptoms in the study population were paroxysmal hemiparesis (5/5), headache (5/5) and focal seizures (1/5). The hemiplegia episodes lasted from 4 h to 7 days. The mean age at the onset of neurological symptoms was 6.8 ± 0.7 years and the mean age at diagnosis was 12.8 ± 1.7 years, with a mean delay of 6.1 ± 1.9 years for the diagnosis. Neuroimaging during acute episodes revealed accentuated gray, white differentiation in the contralateral cerebral hemisphere with mild effacement of sulcal spaces in T2/fluid-attenuated inversion recovery (FLAIR) images. Genetic testing revealed ATP1A2 mutations (FHM2) in 4/5 and SCN1A (FHM3) in 1/5 patients. All of them (5/5) were initiated on oral topiramate and had favorable treatment responses with a mean follow-up duration of 7 ± 1.4 months. Diagnosis of FHM is mainly clinical and can be confirmed by genetic analysis. Perfusion and diffusion-weighted MRI should be considered during acute headache episodes, as it is mostly normal in symptom-free periods. Routine MRI sequences like T1 weighted, T2 weighted, FLAIR and contrast remain normal even during acute attacks.
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Affiliation(s)
- Lokesh Saini
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
| | | | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
| | - Bharat Choudhary
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
| | - Sujatha Manjunathan
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
| | - Ashna Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
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Cresta E, Bellotti A, Rinaldi G, Corbelli I, Sarchielli P. Effect of anti-CGRP-targeted therapy on migraine aura: Results of an observational case series study. CNS Neurosci Ther 2024; 30:e14595. [PMID: 38332541 PMCID: PMC10853579 DOI: 10.1111/cns.14595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/17/2023] [Accepted: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Limited clinical evidence is available regarding the potential effectiveness of anti-CGRP monoclonal antibodies for the preventive treatment of migraine with aura. AIM OF THE STUDY This observational study involved a series of migraine patients affected by either migraine with or without aura, who were investigated for any changes in their frequencies and their migraine aura attack characteristics observed during treatment with anti-CGRP Mabs over a 1-year period. PATIENTS AND METHODS Twelve migraine patients were included, seven of whom were treated with erenumab, 2 with fremanezumab, and 3 with galcanezumab. Clinical data were collected at baseline, which were defined as 3 months prior to the initiation of treatment, and thereafter at each trimester, over the 1-year treatment period. The parameters included the number of headache and migraine days/month, the frequency of aura episodes, the number of days with acute drug intakes/month, and the scores from the migraine disability status scale (MIDAS), and the Headache Impact Test 6 (HIT-6). RESULTS Anti-CGRP Mbs antibodies induced significant decreases in mean headache and migraine without aura days per month, the number of days with medication intake, as well as MIDAS and HIT-6 scores (p < 0.0001). In contrast, the anti-CGRP Mab treatment did not appear to impact the frequency of migraine with aura attacks but seemed to reduce both the intensity and the duration of headache phases of migraine aura. Furthermore, some migraine patients referred to having aura attacks without headache over the course of the treatment period. CONCLUSIONS Based on the above findings, we hypothesize that anti-CGRP Mabs did not influence neuronal and vascular events related to cortical spreading depression (CSD) which is considered the pathophysiological substrate of aura. Conversely, these antibodies are able to counteract, via their peripheral mechanisms of action, the sensitization of the trigemino-vascular pathway which is triggered by CSD. This aforementioned might explain why in our patients, migraine aura attacks remained unchanged in their frequencies, but the headache phases were either reduced or absent.
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Affiliation(s)
- Elena Cresta
- Neurologic ClinicUniversity of PerugiaPerugiaItaly
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Abstract
Targeting CGRP-pathways has substantially expanded our options for treating individuals with migraine. Although the efficacy of these drugs on migraine aura is yet to be fully revealed, it seems from existing studies that CGRP antagonism reduces the number of migraine auras. The present perspective summarizes the evidence linking CGRP to the migraine aura and proposes a model by which targeting the CGRP-pathways and, thus, inhibition the interaction between C- and Aδ-trigeminal fibers might reverse a possible high cortical glutamate level leading to a reduced number of migraine auras.
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Affiliation(s)
- Mohammad Al-Mahdi Al-Karagholi
- Danish Headache Center, Department of Neurology, Rigshospitalet- Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Lee CD, Nappi RE, Cwiak C. Oral Contraceptives for Menstrual Migraine with Aura. N Engl J Med 2023; 389:2102-2104. [PMID: 38048194 DOI: 10.1056/nejmclde2303811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
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Cain SM, Alles SRA, Gopaul R, Bernier LP, Yung AC, Bauman A, Yang Y, Baker GB, Kozlowski P, MacVicar BA, Snutch TP. Chronic pregabalin treatment protects against spreading depolarization and alters hippocampal synaptic characteristics in a model of familial hemiplegic migraine-type 1. Mol Brain 2023; 16:76. [PMID: 37924146 PMCID: PMC10623724 DOI: 10.1186/s13041-023-01062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/04/2023] [Indexed: 11/06/2023] Open
Abstract
Familial hemiplegic migraine type-1 (FHM-1) is a form of migraine with aura caused by mutations in the P/Q-type (Cav2.1) voltage-gated calcium channel. Pregabalin, used clinically in the treatment of chronic pain and epilepsy, inhibits P/Q-type calcium channel activity and recent studies suggest that it may have potential for the treatment of migraine. Spreading Depolarization (SD) is a neurophysiological phenomenon that can occur during migraine with aura by propagating a wave of silenced neuronal function through cortex and sometimes subcortical brain structures. Here, utilizing an optogenetic stimulation technique optimized to allow for non-invasive initiation of cortical SD, we demonstrate that chronic pregabalin administration [12 mg/kg/day (s.c.)] in vivo increased the threshold for cortical spreading depolarization in transgenic mice harboring the clinically-relevant Cav2.1S218L mutation (S218L). In addition, chronic pregabalin treatment limited subcortical propagation of recurrent spreading depolarization events to the striatum and hippocampus in both wild-type and S218L mice. To examine contributing underlying mechanisms of action of chronic pregabalin, we performed whole-cell patch-clamp electrophysiology in CA1 neurons in ex vivo brain slices from mice treated with chronic pregabalin vs vehicle. In WT mice, chronic pregabalin produced a decrease in spontaneous excitatory postsynaptic current (sEPSC) amplitude with no effect on frequency. In contrast, in S218L mice chronic pregabalin produced an increase in sEPSC amplitude and decreased frequency. These electrophysiological findings suggest that in FHM-1 mice chronic pregabalin acts through both pre- and post-synaptic mechanisms in CA1 hippocampal neurons to elicit FHM-1 genotype-specific inhibitory action. The results highlight the potential of chronic pregabalin to limit recurrent SD to subcortical brain structures during pathophysiological events in both the genetically-normal and FHM-1 brain. The work further provides insights into FHM-1 pathophysiology and the potential for chronic pregabalin treatment to prevent SD in migraineurs.
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Affiliation(s)
- Stuart M Cain
- Michael Smith Laboratories, University of British Columbia, 219-2185 East Mall, Vancouver, BC, V6T 1Z4, Canada
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada
| | - Sascha R A Alles
- Michael Smith Laboratories, University of British Columbia, 219-2185 East Mall, Vancouver, BC, V6T 1Z4, Canada
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Ray Gopaul
- Michael Smith Laboratories, University of British Columbia, 219-2185 East Mall, Vancouver, BC, V6T 1Z4, Canada
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada
| | - Louis-Philippe Bernier
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada
| | - Andrew C Yung
- UBC MRI Research Facility, University of British Columbia, Vancouver, Canada
| | - Andrew Bauman
- UBC MRI Research Facility, University of British Columbia, Vancouver, Canada
| | - Yi Yang
- Michael Smith Laboratories, University of British Columbia, 219-2185 East Mall, Vancouver, BC, V6T 1Z4, Canada
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada
| | - Glen B Baker
- Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Piotr Kozlowski
- UBC MRI Research Facility, University of British Columbia, Vancouver, Canada
| | - Brian A MacVicar
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada
| | - Terrance P Snutch
- Michael Smith Laboratories, University of British Columbia, 219-2185 East Mall, Vancouver, BC, V6T 1Z4, Canada.
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada.
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Alstadhaug KB, Tronvik E, Aamodt AH. Transient ischemic attack or migraine with aura? Tidsskr Nor Laegeforen 2023; 143:23-0225. [PMID: 37874053 DOI: 10.4045/tidsskr.23.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Abstract
Migraine or migraine-like symptoms can contribute to a delayed stroke diagnosis. However, migraine with aura is a common stroke mimic and often the basis for acute thrombolytic therapy. It is probably also the reason why many patients are misdiagnosed with a transient ischemic attack. In this clinical review, we explain the factors that could differentiate a transient ischemic attack from a migraine with aura.
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Alhayek N, Harahsheh E, Dumitrascu O, Green AL. A Case Report of Migraine With Aura Worsened After Starting Apixaban and Literature Review. Neurologist 2023; 28:335-337. [PMID: 37582651 DOI: 10.1097/nrl.0000000000000513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Multiple medications have been related to triggering headache attacks or worsening headache frequency or severity in patients with migraine disease. However, the impact of direct oral anticoagulants on headache frequency and severity in patients with migraine disease is unclear. Current literature is scarce and controversial. CASE REPORT A 45-year-old male with a history of migraine with aura for the last 20 years underwent percutaneous transcatheter closure of an atrial septal defect due to right ventricular enlargement and systolic dysfunction. The intervention was complicated by postprocedural atrial fibrillation, for which he was started on apixaban. Shortly after starting the apixaban, the patient experienced an increase in the frequency and severity of his migraine with aura episodes that were persistent until he discontinued this medication 7 months later. Following the discontinuation of apixaban, the patient's frequency and severity of migraine episodes returned to baseline almost immediately. CONCLUSION Novel oral anticoagulants, including apixaban, may be associated with an increase in the frequency and severity of migraine attacks in patients with migraine disease. Larger observational studies are required to investigate further the impact of direct oral anticoagulants on migraine disease.
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Affiliation(s)
- Nour Alhayek
- Department of Neurology, Mayo Clinic Arizona, Scottsdale, AZ
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Slomski A. Erenumab Safe, Effective for Patients With Migraine With Aura. JAMA 2022; 327:804. [PMID: 35230406 DOI: 10.1001/jama.2022.2186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Viard D, Gérard A, Tahiri J, Tieulié N, Van Obberghen E, Drici MD. Triptan overuse during pregnancy: a possible cause of placental hypoperfusion. Eur J Clin Pharmacol 2020; 77:269-270. [PMID: 32886179 DOI: 10.1007/s00228-020-02991-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/01/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Delphine Viard
- Department of Pharmacology, Pharmacovigilance Center, University Hospital of Nice, Nice, France.
| | - Alexandre Gérard
- Department of Pharmacology, Pharmacovigilance Center, University Hospital of Nice, Nice, France
| | - Jellila Tahiri
- Department of Obstetrics and Gynecology, University Hospital of Nice, Nice, France
| | - Nathalie Tieulié
- Department of Rheumatology, University Hospital of Nice, Nice, France
| | - Elise Van Obberghen
- Department of Pharmacology, Pharmacovigilance Center, University Hospital of Nice, Nice, France
| | - Milou-Daniel Drici
- Department of Pharmacology, Pharmacovigilance Center, University Hospital of Nice, Nice, France
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Tang C, Unekawa M, Kitagawa S, Takizawa T, Kayama Y, Nakahara J, Shibata M. Cortical spreading depolarisation-induced facial hyperalgesia, photophobia and hypomotility are ameliorated by sumatriptan and olcegepant. Sci Rep 2020; 10:11408. [PMID: 32651400 PMCID: PMC7351983 DOI: 10.1038/s41598-020-67948-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/17/2020] [Indexed: 01/14/2023] Open
Abstract
Cortical spreading depolarisation (CSD), the neural mechanism underlying migraine aura, may cause headache by sensitising the trigeminal system. Photophobia, the most bothersome accompanying symptom during migraine attacks, is more prevalent in migraine with aura than in migraine without aura. Whether CSD plays a role in developing photophobia remains unknown. Moreover, migraine-induced physical hypoactivity contributes to loss of productivity. We aimed to investigate the development of trigeminal sensitisation, photophobia and locomotive abnormality after KCl-induced CSD using 86 male C57BL/6 mice. Sham-operated mice were used as controls. We confirmed the presence of trigeminal sensitisation and photophobia at 24 h after CSD. CSD-subjected mice also exhibited significantly reduced locomotive activity in both light and dark zones. Hence, the CSD-induced hypomobility was likely to be independent of photophobia. The 5-HT1B/1D agonist, sumatriptan, corrected all these CSD-induced abnormalities. Moreover, dose dependency was demonstrated in the ameliorating effect of the calcitonin gene-related peptide (CGRP) receptor antagonist, olcegepant, on these abnormalities. Sumatriptan and olcegepant improved mouse locomotion with therapeutic lags ranging from 20 to 30 min. Collectively, CSD caused trigeminal sensitisation, photophobia and hypomobility that persisted for at least 24 h by a mechanism involving the 5-HT1B/1D and CGRP activity.
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Affiliation(s)
- Chunhua Tang
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, 10 Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China
| | - Miyuki Unekawa
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Satoshi Kitagawa
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yohei Kayama
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mamoru Shibata
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Liktor-Busa E, Blawn KT, Kellohen KL, Wiese BM, Verkhovsky V, Wahl J, Vivek A, Palomino SM, Davis TP, Vanderah TW, Largent-Milnes TM. Functional NHE1 expression is critical to blood brain barrier integrity and sumatriptan blood to brain uptake. PLoS One 2020; 15:e0227463. [PMID: 32469979 PMCID: PMC7259629 DOI: 10.1371/journal.pone.0227463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/04/2020] [Indexed: 12/31/2022] Open
Abstract
Disruption of blood-brain barrier integrity and dramatic failure of brain ion homeostasis including fluctuations of pH occurs during cortical spreading depression (CSD) events associated with several neurological disorders, including migraine with aura, traumatic brain injury and stroke. NHE1 is the primary regulator of pH in the central nervous system. The goal of the current study was to investigate the role of sodium-hydrogen exchanger type 1 (NHE1) in blood brain barrier (BBB) integrity during CSD events and the contributions of this antiporter on xenobiotic uptake. Using immortalized cell lines, pharmacologic inhibition and genetic knockdown of NHE1 mitigated the paracellular uptake of radiolabeled sucrose implicating functional NHE1 in BBB maintenance. In contrast, loss of functional NHE1 in endothelial cells facilitated uptake of the anti-migraine therapeutic, sumatriptan. In female rats, cortical KCl but not aCSF selectively reduced total expression of NHE1 in cortex and PAG but increased expression in trigeminal ganglia; no changes were seen in trigeminal nucleus caudalis. Thus, in vitro observations may have a significance in vivo to increase brain sumatriptan levels. Pharmacological inhibition of NHE1 prior to cortical manipulations enhanced the efficacy of sumatriptan at early time-points but induced facial sensitivity alone. Overall, our results suggest that dysregulation of NHE1 contributes to breaches in BBB integrity, drug penetrance, and the behavioral sensitivity to the antimigraine agent, sumatriptan.
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Affiliation(s)
- Erika Liktor-Busa
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Kiera T. Blawn
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Kathryn L. Kellohen
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Beth M. Wiese
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Vani Verkhovsky
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Jared Wahl
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Anjali Vivek
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Seph M. Palomino
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Thomas P. Davis
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Todd W. Vanderah
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Tally M. Largent-Milnes
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
- * E-mail:
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Abstract
The most common type of migraine aura is multifaceted visual aura, such as scintillating scotoma or geometrical patterns, visual hallucinations in which a physical body is extremely rare. We report a paediatric case of migraine in which visual hallucinations appeared as auras in the form of a human body. The patient was an 11-year-old girl suffering from migraine with curious visual aura. The auras were atypical visual hallucinations that were sometimes accompanied by auditory hallucinations. Approximately 5-20 min before the headache, the patient would see a middle-aged man wearing sunglasses in her field of vision. Acetaminophen (10 mg/kg) and Japanese herbal medicine administered when necessary effectively treated the headaches. Finally, the patient was no longer complaining of her hallucination auras. Although the pathophysiology of migraines accompanied by auras is unclear, it appears that cerebral blood flow and cortical spreading depression are involved in auras.
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Affiliation(s)
- Osamu Akiyama
- Department of Neurosurgery, Juntendo University, Tokyo, Japan
- Akiyama Neuro Surgery Clinic, Yamanashi, Japan
| | - Akihide Kondo
- Department of Neurosurgery, Juntendo University, Tokyo, Japan
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Altamura C, Paolucci M, Brunelli N, Cascio Rizzo A, Cecchi G, Assenza F, Silvestrini M, Vernieri F. Right-to-left shunts and hormonal therapy influence cerebral vasomotor reactivity in patients with migraine with aura. PLoS One 2019; 14:e0220637. [PMID: 31369637 PMCID: PMC6675040 DOI: 10.1371/journal.pone.0220637] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023] Open
Abstract
Patent Foramen Ovale and impaired cerebral hemodynamics were proposed among the pathophysiological mechanisms explaining the increased risk for stroke in patients with Migraine with Aura (MA). Our study aimed at comparing the vasomotor reactivity (VMR) of the anterior and the posterior cerebral circulation in patients with Migraine with Aura, in patients with acute vascular ischemic accidents, and in controls. We hypothesized that VMR in MA patients is preserved in the anterior circulation and reduced in the posterior circulation. We prospectively assessed with Transcranial Doppler the vasomotor reactivity to breath holding of the Middle and Posterior Cerebral Arteries (MCA, PCA) in MA patients, in acute vascular patients and healthy controls. We also evaluated the possible effect of clinical characteristics of MA (attack frequency, aura length or type, disease history), vascular factors and the presence of right-to-left shunt on VMR. Diverging from our hypothesis, MA patients displayed a higher breath-holding index (BHI) than controls in the MCA (1.84±0.47%/s vs 1.53±0.47%/s, p = .001) as well as in the PCA (1.87±0.65%/s vs 1.47±0.44%/s, p < .001). In MA patients, MCA BHI was higher in those with large right-to-left shunts (2.09±0.42 vs 1.79±0.47, p = .046) and lower in those taking estrogens (1.30±0.30%/s vs 1.9±0.45%/s, p = .009). We did not observe an effect of MA characteristics on BHI. The increased BHI in MA patients with large right-to-left shunts could be explained by the vasoactive effect in the cerebral circulation of substances bypassing the deactivating pulmonary filters or by a constitutional trait of the vascular system associating persistent right-to-left shunts and hyper-reactive hemodynamics. Our results discourage the hypothesis that altered hemodynamics contribute to increasing the stroke risk in all MA patients. However, estrogens can lower VMR, curtailing the hemodynamic resources of MA patients.
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Affiliation(s)
- Claudia Altamura
- Clinical Neurology, Headache and Neurosonology Unit, Campus Bio-Medico University of Rome, Roma, Italy
- * E-mail:
| | - Matteo Paolucci
- Clinical Neurology, Headache and Neurosonology Unit, Campus Bio-Medico University of Rome, Roma, Italy
| | - Nicoletta Brunelli
- Clinical Neurology, Headache and Neurosonology Unit, Campus Bio-Medico University of Rome, Roma, Italy
| | - Angelo Cascio Rizzo
- Clinical Neurology, Headache and Neurosonology Unit, Campus Bio-Medico University of Rome, Roma, Italy
| | - Gianluca Cecchi
- Clinical Neurology, Headache and Neurosonology Unit, Campus Bio-Medico University of Rome, Roma, Italy
| | - Federica Assenza
- Clinical Neurology, Headache and Neurosonology Unit, Campus Bio-Medico University of Rome, Roma, Italy
| | - Mauro Silvestrini
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Fabrizio Vernieri
- Clinical Neurology, Headache and Neurosonology Unit, Campus Bio-Medico University of Rome, Roma, Italy
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Csongradi C. Beta Blocker Eye Drops Have Dramatically Helped My Severe Migraines. Mo Med 2018; 115:525. [PMID: 30643345 PMCID: PMC6312174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Carolyn Csongradi
- Carolyn Csongradi has a BS in chemistry from UC-Berkeley, Master degrees in neurosciences, and also education from Stanford University. She is a former adjunct faculty member of Santa Clara University
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Rossi FH, Gonzalez E, Rossi EM, Tsakadze N. Exploding Head Syndrome as Aura of Migraine with Brainstem Aura: A Case Report. J Oral Facial Pain Headache 2018; 32:e34-e36. [PMID: 29694468 DOI: 10.11607/ofph.1950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This article reports a case of exploding head syndrome (EHS) as an aura of migraine with brainstem aura (MBA). A middle-aged man presented with intermittent episodes of a brief sensation of explosion in the head, visual flashing, vertigo, hearing loss, tinnitus, confusion, ataxia, dysarthria, and bilateral visual impairment followed by migraine headache. The condition was diagnosed as MBA. Explosive head sensation, sensory phenomena, and headaches improved over time with nortriptyline. This case shows that EHS can present as a primary aura symptom in patients with MBA.
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Affiliation(s)
- Sheba Jarvis
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Pooja Dassan
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
- Department of Neurology, Ealing Hospital, London North West Healthcare NHS Trust, Uxbridge Road, Southall UB1 3HW, UK
| | - Catherine Nelson Piercy
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
- Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH
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Palmieri A, Mainardi F, Maggioni F, Dainese F, Zanchin G. Hemicrania Continua Evolving from Migraine with Aura: Clinical Evidence of a Possible Correlation Between Two Forms of Primary Headache. Cephalalgia 2016; 24:1007-8. [PMID: 15482368 DOI: 10.1111/j.1468-2982.2004.00795.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Zeller JA, Lindner V, Frahm K, Baron R, Deuschl G. Platelet Activation and Platelet-Leucocyte Interaction in Patients with Migraine. Subtype Differences and Influence of Triptans. Cephalalgia 2016; 25:536-41. [PMID: 15955041 DOI: 10.1111/j.1468-2982.2005.00916.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As migraine is the result of an inflammatory mechanism with serotonergic signalling, leucocyte function, platelet function and intercellular communication between those cells is likely to be connected to the final pathway of the disease. We examined P-selectin expression on platelets (platelet activation) and leucocyte-platelet aggregate formation in 72 migraine patients during their attack-free interval and controls using a flow cytometric assay. Patients suffering from migraine without aura had a significantly increased platelet activation and leucocyte-platelet aggregation compared with the control group, unlike the migraine patients with aura. Patients who had taken a triptan within 3 days prior to the investigation showed platelet activation values similar to the control group. The variations in platelet activation patterns of migraine subgroups could indicate different pathomechanisms. Even outside an attack, migraine patients, particularly those without aura, show an increased level of platelet activation which seems to be down-regulated by triptans. This mechanism may account for the triptan-induced increases in headache frequency. The involvement of proinflammatory platelet-leucocyte cross-talk suggests a possible therapeutic strategy using anti-inflammatory drugs.
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Affiliation(s)
- J A Zeller
- Department of Neurology, Christian-Albrechts-University Kiel, Kiel, Germany.
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Affiliation(s)
- P S Sándor
- Headache & Pain Unit, Neurology Department, University Hospital Zurich, Zurich, Switzerland.
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Abstract
The objectives of this study were to assess the proportion of subjects with strict migraine (SM, migraine with and without aura), probable migraine (PM), and all migraine (AM, SM and PM pooled together), who receive a medical diagnosis or a specific treatment within a health plan. Eligible participants were 18-55-year participants of a non-profit health maintenance organization (HMO) who had received out-patient, emergency department, or in-patient care from a physician within the past year. We used a validated computer-assisted telephone interview (CATI) survey to identify SM, PM and controls (received out-patient, emergency department, or in-patient care from a physician for any reason within the past year, but did not have SM or PM). Medical and prescription drug claims for the 24-month period were linked to participant files. Among 8579 respondents, we identified 1265 SM sufferers and 1252 PM sufferers, which were compared with 960 randomly selected controls. Just 194 (15.3%) SM, 21 (1.7%) PM, and 215 (8.5%) AM sufferers received an in-patient or out-patient primary migraine claim in the previous 24 months, compared with six (0.5%) controls; 240 (18.9%) SM, 39 (3.1%) PM, 279 (11.1%) AM sufferers, and eight controls (0.6%) received any migraine claim. There were claims for migraine drugs (ICD-9 code for triptans or ergot compounds) for just 140 (11.1%) SM and 34 (2.7%) PM sufferers, and migraine analgesics (butalbital and isomethepthene compounds), for 6.3% SM and 2.2% PM sufferers (0.7% of the controls). Migraine preventives were used for a larger number of SM and PM sufferers (19.6% and 13.1%), but also for controls (10.5%), indicating that they were probably used for other medical reasons. Both SM and PM are underdiagnosed and undertreated within a health plan. Educational strategies should focus on physician education addressing diagnosing the full spectrum of migraine and physician management of migraine with specific migraine therapy in appropriate patients.
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Affiliation(s)
- M E Bigal
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, NY, USA
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21
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Fueßl HS, Stiefelhagen P. [St. John's Wort for aura and vertigo]. MMW Fortschr Med 2015; 157:24. [PMID: 26783610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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22
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Abstract
We describe a case of a 45-year-old man who presented with a transient syndrome consisting of headache with neurological deficits. Neuroimaging including brain angiography was normal. Cerebrospinal fluid (CSF) analysis revealed an elevated protein and lymphocytic pleocytosis. The diagnosis of a syndrome of Headache and Neurological Deficits with CSF Lymphocytosis (HaNDL) was made after excluding all the other possible causes for the patient's presentation. He made an excellent recovery following a short course of naproxen sodium.
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Affiliation(s)
| | - Enda McGowan
- Department of Neurology, HSE West, Galway, Ireland
| | - Hugh Kearney
- Department of Neurology, HSE West, Galway, Ireland
| | - Timothy J Counihan
- Department of Neurology, National University of Ireland, Galway, Galway, Ireland
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Kung SL, Shen CY, Ling TT. Migraine-like Visual Aura Rriggered by a Large Aneurysm in the Left Extracranial Internal Carotid Artery with Successful Prevention of Recurrence by the new Anticoagulant Dabigatran: First Case Report. Acta Neurol Taiwan 2015; 24:19-24. [PMID: 26179686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE We present a rare case of late-onset migraine-like visual aura triggered by a large aneurysm in the left extracranial internal carotid artery. To the best of our knowledge, this is the first case of migraine-like visual aura triggered by an extracranial internal carotid artery (ICA) aneurysm. This is also the first case of migraine-like visual aura with probable thromboembolic trigger being successfully treated with a new anticoagulant, dabigatran. CASE REPORT A 61-year-old woman complained about stereotypical episodes of a short-lasting flickering light in the right visual field for about half a year. Magnetic resonance imaging (MRI) of the head revealed a large aneurysm arising from the mid-cervical portion of the left internal carotid artery (ICA). After anticoagulant therapy with 110 mg of dabigatran twice a day, she became free from the visual symptom. CONCLUSION Late-onset migraine with aura, especially typical aura without headache should be diagnosed carefully since it can be a challenge to distinguish it from signaling something serious. Micro-thromboembolism, commonly cardiogenic, but rarely arising from a carotid aneurysm, can trigger cerebral ischemic injury, causing transient neuronal hyperexcitability and cortical spreading depression (CSD)-like ''spontaneous'' waves propagating through the penumbra of the injured region into normally perfused tissue. The resultant symptoms may semiologically mimic visual aura. Migraine-like visual aura in this patient was successfully treated with dabigatran. It may not only imply that the patient's migraine-like visual aura was a thromboembolic event, but may also suggest the potential efficacy of the new anticoagulant, dabigatran, as the optimal alternative of warfarin in treating a thromboembolic event arising from a carotid aneurysm.
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Affiliation(s)
- Sheng-Ling Kung
- Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chao-Yu Shen
- School of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ting-Ting Ling
- School of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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24
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Abstract
Migraine is a common disabling headache disorder characterized by recurrent episodes sometimes preceded or accompanied by focal neurological symptoms called aura. The relation between two subtypes, migraine without aura (MWoA) and migraine with aura (MWA), is explored with the aim to identify targets for neuromodulation techniques. To this end, a dynamically regulated control system is schematically reduced to a network of the trigeminal nerve, which innervates the cranial circulation, an associated descending modulatory network of brainstem nuclei, and parasympathetic vasomotor efferents. This extends the idea of a migraine generator region in the brainstem to a larger network and is still simple and explicit enough to open up possibilities for mathematical modeling in the future. In this study, it is suggested that the migraine generator network (MGN) is driven and may therefore respond differently to different spatio-temporal noxious input in the migraine subtypes MWA and MWoA. The noxious input is caused by a cortical perturbation of homeostasis, known as spreading depression (SD). The MGN might even trigger SD in the first place by a failure in vasomotor control. As a consequence, migraine is considered as an inherently dynamical disease to which a linear course from upstream to downstream events would not do justice. Minimally invasive and noninvasive neuromodulation techniques are briefly reviewed and their rational is discussed in the context of the proposed mechanism.
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Affiliation(s)
- Markus A Dahlem
- Institute of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
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Stavrou M, Solomou S, Spooner O, Perry R. A young woman presenting with severe headache. BMJ 2013; 346:f2448. [PMID: 23704126 DOI: 10.1136/bmj.f2448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Maria Stavrou
- North Central Thames Foundation School, London WC1E6BT, UK.
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26
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Verrecchia F, Farge-Bancel D. [ Gap junctional intercellular communication]. ACTA ACUST UNITED AC 2012. [PMID: 23206435 DOI: 10.1016/j.patbio.2012.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- S Evers
- Neurologische Klinik, Krankenhaus Lindenbrunn, D-31861 Coppenbrügge.
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Pieroni A, Caso V, Cittadini E, Hamam M, Paciaroni M. A case of typical headache with an atypical diagnosis. Intern Emerg Med 2012; 7 Suppl 2:S121-3. [PMID: 22669554 DOI: 10.1007/s11739-012-0788-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 05/05/2012] [Indexed: 10/28/2022]
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Huang L, Yu CY, Wang BN, Zhang HM, Li LY, Wang Y. Vertebrobasilar dolichoectasia causing a presentation resembling basilar-type migraine. Clin Neurol Neurosurg 2012; 115:784-6. [PMID: 22877683 DOI: 10.1016/j.clineuro.2012.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/07/2012] [Accepted: 07/05/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Lin Huang
- Department of Neurology, Epilepsy and Headache Group, The First Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
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Bartolini M, Giamberardino MA, Lisotto C, Martelletti P, Moscato D, Panascia B, Savi L, Pini LA, Sances G, Santoro P, Zanchin G, Omboni S, Ferrari MD, Brighina F, Fierro B. A double-blind, randomized, multicenter, Italian study of frovatriptan versus almotriptan for the acute treatment of migraine. J Headache Pain 2011; 12:361-8. [PMID: 21437714 PMCID: PMC3094646 DOI: 10.1007/s10194-011-0325-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 02/21/2011] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to evaluate patients’ satisfaction with acute treatment of migraine with frovatriptan or almotriptan by preference questionnaire. One hundred and thirty three subjects with a history of migraine with or without aura (IHS 2004 criteria), with at least one migraine attack in the preceding 6 months, were enrolled and randomized to frovatriptan 2.5 mg or almotriptan 12.5 mg, treating 1–3 attacks. The study had a multicenter, randomized, double blind, cross-over design, with treatment periods lasting <3 months. At study end patients assigned preference to one of the treatments using a questionnaire with a score from 0 to 5 (primary endpoint). Secondary endpoints were pain free and pain relief episodes at 2 and 4 h, and recurrent and sustained pain free episodes within 48 h. Of the 133 patients (86%, intention-to-treat population) 114 of them expressed a preference for a triptan. The average preference score was not significantly different between frovatriptan (3.1 ± 1.3) and almotriptan (3.4 ± 1.3). The rates of pain free (30% frovatriptan vs. 32% almotriptan) and pain relief (54% vs. 56%) episodes at 2 h did not significantly differ between treatments. This was the case also at 4 h (pain free: 56% vs. 59%; pain relief: 75% vs. 72%). Recurrent episodes were significantly (P < 0.05) less frequent under frovatriptan (30% vs. 44%), also for the attacks treated within 30 min. No significant differences were observed in sustained pain free episodes (21% vs. 18%). The tolerability profile was similar between the two drugs. In conclusion, our study suggests that frovatriptan has a similar efficacy of almotriptan in the short-term, while some advantages are observed during long-term treatment.
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Affiliation(s)
| | | | - Carlo Lisotto
- Ospedale Civile San Vito al Tagliamento, San Vito al Tagliamento, Italy
| | | | | | | | - Lidia Savi
- Department of Neurology, University of Torino, Turin, Italy
| | - Luigi Alberto Pini
- Inter Department Headache and Drug abuse Center, Modena University, Modena, Italy
| | | | | | - Giorgio Zanchin
- Department of Neurology, University of Padova, Padova, Italy
| | | | - Michel D. Ferrari
- Leiden Centre for Translational Neuroscience, Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Filippo Brighina
- Department of Experimental Medicines and Neurological Sciences (BioNec), University of Palermo, Palermo, Italy
| | - Brigida Fierro
- Department of Experimental Medicines and Neurological Sciences (BioNec), University of Palermo, Via La Loggia 1, 90100 Palermo, Italy
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32
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Koreshkina MI. [Modern methods of neurovisualization and preventive treatment of migraine]. Zh Nevrol Psikhiatr Im S S Korsakova 2011; 111:25-31. [PMID: 22027603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Forty-eight patients have been examined in the Centre of Headache Treatment. MRI of the brain revealed the changes in the white matter in 69% of patients, 39% had multiple foci (more than 3). The largest number of foci was seen in patients with frequent and chronic migraine without aura, but not in those with migraine with aura. The foci were located more often in frontal areas and less often in parietal and temporal areas. Twenty-three patients with frequent and chronic migraine received the preventive treatment with the anticonvulsant topiramate (topamax, capsules 25 and 50 mg). The duration of treatment was from 4 to 12 months depending on the disease severity. The decrease in frequency of migraine attacks was seen after 1 month of the treatment. After 6 months, mean score on the MIDAS decreased from 26.5 that indicated the severity of migraine and significant decrease in working capacity to 5.7 that corresponded to the mild form of migraine.
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33
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Palikh GM, Vaughn BV. Topiramate responsive exploding head syndrome. J Clin Sleep Med 2010; 6:382-3. [PMID: 20726288 PMCID: PMC2919670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Exploding head syndrome is a rare phenomenon but can be a significant disruption to quality of life. We describe a 39-year-old female with symptoms of a loud bang and buzz at sleep onset for 3 years. EEG monitoring confirmed these events occurred in transition from stage 1 sleep. This patient reported improvement in intensity of events with topiramate medication. Based on these results, topiramate may be an alternative method to reduce the intensity of events in exploding head syndrome.
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Affiliation(s)
- Gaurang M. Palikh
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Bradley V. Vaughn
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC
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34
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35
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Alemdar M, Selekler HM, Komsuoğlu SS. [Temporal characteristics of migraine-type headache]. Agri 2009; 21:168-174. [PMID: 20127538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Migraine is characterized by headache attacks, and symptoms belong to various organ systems. Temporal characteristics of headache must be known to prescribe the appropriate drug for the treatment of migraine attacks. In this study, we aimed to reveal the temporal characteristics of headache and to search whether or not these characteristics differ in patient subgroups in migraineurs admitted to a tertiary health center. METHODS Consecutive adult migraineurs who admitted to the Headache Section of Kocaeli University Faculty of Medicine Research Hospital involved the study. Their demographical data, medical history and temporal characteristics of headaches were questioned. RESULTS Thirty (19.6%) patients among the 153 migraineurs involved had chronic daily headache. Headaches were detected to reach the maximum pain intensity within 2 hours in 34 patients (22.2%) and to continue over 24 hours in 87 (56.9%) patients. Patients with headaches lasting over 24 hours had a greater mean age than of those with headaches ending within 24 hours (40.8+/-12.4 and 36.2+/-11.4, respectively; p=0.019). The mean disease age of the patients with headaches lasting over 24 hours was also greater than of the group with headaches ending within 24 hours. CONCLUSION Our study revealed that temporal characteristics of headache may differ in patient subgroups in adult migraineurs. Further studies with large populations are warranted to verify these results and determine which temporal characteristics are common in which patient subgroups.
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Affiliation(s)
- Murat Alemdar
- Department of Neurology, Sakarya Yenikent State Hospital, Adapazari/Sakarya, Turkey.
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36
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Abstract
Visual aura is the most common feature associated with migraine, though it can occur separately. In both cases it often represents a dramatic event, especially for patients who experience it for the first time. Besides, its subjective characteristics may illuminate on the functional architecture of the visual cortex. Repetitive events of migraine and visual aura have been suggested to affect the visual system in the long run, both on the cortical and precortical level. In effect, objective investigation of visual functions in patients support the idea that a selective damage does occur, so that more attention to visual examination seems to be justified. In this paper, subjective and psychophysical aspects of visual aura are examined, lastly highlighting and discussing the interesting correlations found between this condition and normal-tension glaucoma.
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Affiliation(s)
- Carlo Aleci
- Ophthalmology Department, Gradenigo Hospital, Cso R Margherita 8, 10153 Turin, Italy.
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37
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Vetter C. [Migraine can signal a risk for heart and brain]. MMW Fortschr Med 2009; 151:17. [PMID: 19827419 DOI: 10.1007/bf03365809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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38
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Tobis J. The conundrum of migraine headaches in the presence of patent foramen ovale. Catheter Cardiovasc Interv 2009; 74:130-1. [PMID: 19530214 DOI: 10.1002/ccd.22144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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39
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Sacco S, Rasura M, Cao M, Bozzao A, Carolei A. CADASIL presenting as status migrainosus and persisting aura without infarction. J Headache Pain 2009; 10:51-3. [PMID: 18953486 PMCID: PMC3451763 DOI: 10.1007/s10194-008-0079-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 10/08/2008] [Indexed: 11/21/2022] Open
Abstract
Different types of migraine have been reported in 20-40% of patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). We describe a novel migrainous manifestation of CADASIL consisting in status migrainosus and persistent aura without infarction. The symptoms resolved after i.v. treatment with lorazepam and mannitol.
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Affiliation(s)
- Simona Sacco
- Department of Neurology, The Regional Headache Referral Center, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67010 L’Aquila, Italy
| | - Maurizia Rasura
- Department of Neurology, University of Roma, La Sapienza, Rome, Italy
| | - Marina Cao
- Department of Neurology, University of Roma, La Sapienza, Rome, Italy
| | - Alessandro Bozzao
- Department of Neuroradiology, University of Roma, La Sapienza, Rome, Italy
| | - Antonio Carolei
- Department of Neurology, The Regional Headache Referral Center, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67010 L’Aquila, Italy
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40
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Affiliation(s)
| | - Inês Alice Teixeira Leão
- Headache Outpatient Unit, Hospital da Polícia Militar de Minas Gerais - Belo Horizonte/MG Brazil
| | - João Bosco Lima Gomes
- Headache Outpatient Unit, Hospital da Polícia Militar de Minas Gerais - Belo Horizonte/MG Brazil
- Headache Clinic, Department of Internal Medicine, Faculdade de Medicina da Universidade Federal de Minas Gerais - Belo Horizonte/MG Brazil
| | - Ariovaldo Alberto da Silva
- Headache Clinic, Department of Internal Medicine, Faculdade de Medicina da Universidade Federal de Minas Gerais - Belo Horizonte/MG Brazil
| | - Antonio Lucio Teixeira
- Headache Clinic, Department of Internal Medicine, Faculdade de Medicina da Universidade Federal de Minas Gerais - Belo Horizonte/MG Brazil
- , Tel.: 55 31 3409.2651
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41
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Abstract
Cortical spreading depression (CSD) is a transient (60-120 s) and at 3-5 mm/min propagating depolarization wave of cortical neurons and glial cells and is characterized by a DC shift of 20-35 mV. It is accompanied by massive redistribution of ions between extracellular and intracellular compartments and by a water influx into the cells. Extracellular potassium ion concentration increases up to 60 mM/l. Potassium ions and the excitatory neurotransmitter glutamate essentially contribute to the initiation and propagation of CSD. Both depolarization and disturbance of brain ion homeostasis regenerate within a few minutes while enhancing energy metabolism, but do not cause damage to normally perfused brain tissue. The similar propagation velocity of CSD and visual scotoma during migraine aura led to the assumption that CSD could be the underlying mechanism of migraine aura. The observation of CSD waves in migraine aura patients with the magnet encephalogram (MEG) technique confirmed this theory. Although many data support the relationship between CSD and aura phase in migraine, the role of CSD in migraine headache is still disputed.
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Affiliation(s)
- F Richter
- Institut für Physiologie I/Neurophysiologie, Friedrich-Schiller-Universität Jena, Teichgraben 8, 07740 Jena, Deutschland.
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Fernández-Díaz A, Alvarez-Gutiérrez J, Isern-Longares J, Andrés-Celda MR, Pérez-Ruiz D, Buelta-González C. [Migraine auras without headache that respond to topiramate]. Rev Neurol 2008; 47:164. [PMID: 18654972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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43
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Ormstad H, Amthor KF. [Migraine: physiopathology, genetics and treatment aspects. The knowledge situation summarized]. Lakartidningen 2008; 105:2098-2102. [PMID: 18751448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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44
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Kawamura S, Sakai A, Endo T, Maruta M. Atypical depression as a premonitory symptom of migraine managed by an oral contraceptive. Psychiatry Clin Neurosci 2008; 62:365. [PMID: 18588602 DOI: 10.1111/j.1440-1819.2008.01808.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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45
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Bartsch T. [Diagnosis and therapy of migraine aura]. MMW Fortschr Med 2008; 150 Suppl 2:48-50. [PMID: 18680839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- T Bartsch
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel.
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46
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Young WB. Cessation of hemiplegic migraine auras with greater occipital nerve blockade: a comment. Headache 2008; 48:481. [PMID: 18205798 DOI: 10.1111/j.1526-4610.2007.01042.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hsu DA, Stafstrom CE, Rowley HA, Kiff JE, Dulli DA. Hemiplegic migraine: hyperperfusion and abortive therapy with intravenous verapamil. Brain Dev 2008; 30:86-90. [PMID: 17614229 DOI: 10.1016/j.braindev.2007.05.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 04/23/2007] [Accepted: 05/24/2007] [Indexed: 10/23/2022]
Abstract
A 20-year-old female with hemiplegic migraine was treated during an acute attack with intravenous verapamil, which reproducibly resolved the headache within 20 min but did not affect her hemiplegia. Magnetic resonance (MR) and computed tomographic (CT) angiography and perfusion performed during the attack showed vasodilation and hyperperfusion. Cerebral hyperperfusion concurrent with hemiplegia suggests a dissociation between cerebral perfusion and neuronal function in hemiplegic migraine. The beneficial effect of verapamil on headache but not hemiplegia suggests a distinct mechanism for pain and neuronal dysfunction in hemiplegic migraine, with the beneficial effect on pain not due to vasodilation.
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Affiliation(s)
- David A Hsu
- Department of Neurology H6/526, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA.
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Fernández-Díaz A, Alonso-Navarro H, Adeva-Bartolomé MT, Pérez-Macho L, Ruiz-Ezquerro JJ, Martín-Prieto M. [Muscle cramps and myalgia related to zolmitriptan]. Rev Neurol 2007; 45:639. [PMID: 18008273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Abstract
The objective of this study was to investigate the efficacy, safety and tolerability of triptans in patients who suffer from familial or sporadic hemiplegic migraine. Seventy-six subjects had used triptans at least once as an abortive treatment. Average triptan response was 6.9 (SD +/-3.1) and adverse event severity 4.9 (SD +/-3.3) on a scale from 0 to 10 (no response or side effect 0, excellent response or unbearable side effects 10). None of the patients had an ischaemic stroke or a heart attack. One patient reported prolonged neurological symptoms, related to a single dose of rizatriptan, but there were no pathological findings in several MRI-scans. Triptans seem to be safe and effective treatment for most hemiplegic migraine patients.
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Affiliation(s)
- V Artto
- Department of Neurology, Helsinki University Central Hospital, Finland.
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