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Background: Night-shift work, exposure to artificial light-at-night (ALAN) and particularly blue light spectrum, and the consequent circadian disruption may increase the risk of breast and prostate cancer. Colorectal cancer risk may also be increased among night-shift workers. We investigated the association between exposure to ALAN according to light spectrum and colorectal cancer among subjects who had never worked at night in a general population case-control study in Spain., Methods: We examined information on 661 incident histologically verified colorectal cancer cases and 1,322 controls from Barcelona and Madrid, 2007-2013. Outdoor ALAN exposure was based on images from the International Space Station (ISS) including data on remotely sensed upward light intensity. We derived adjusted odds ratio (OR) estimates and confidence intervals (CI) for visual light, blue light, and spectral sensitivities of the five human photopigments assigned to participant's geocoded longest residence., Results: Exposure to blue light spectrum was positively associated with colorectal cancer (OR = 1.6; 95% CI: 1.2-2.2; highest vs. lowest tertile). ORs were similar (OR = 1.7; 95% CI: 1.3-2.3) when further adjusting for area socioeconomic status, diet patterns, smoking, sleep, and family history. We observed no association for outdoor visual light (full spectrum) (OR = 1.0; 95% CI, 0.7-1.2; highest vs. lowest tertile). Analysis of the five photopigments gave similar results with increased risks for shorter wavelengths overlapping with the blue spectrum and no association for longer wavelengths., Conclusions: Outdoor blue light spectrum exposure that is increasingly prevalent in recent years may be associated with colorectal cancer risk. See video abstract: http://links.lww.com/EDE/B708.

Background: Altered serotonin (5-HT) neurotransmission has been implicated in the pathophysiology of migraine headache., Objectives: To test this hypothesis in migraine patients in vivo using PET and alpha-[(11)C]methyl-l-tryptophan as a surrogate marker of brain 5-HT synthetic rate during different phases of their migraine attack and after acute antimigraine therapy with sumatriptan, and to compare them with normal controls., Methods: Six patients were scanned 1) within 6 hours after the onset of a spontaneous migraine attack, 2) 2 hours after subcutaneous sumatriptan, and 3) interictally when migraine free for at least 3 days. Head pain was rated before each scan, and before and every 15 minutes after sumatriptan., Results: Brain 5-HT synthesis was highest during attacks, lowest after sumatriptan, and intermediate when patients were migraine free. All states were statistically different from the others in virtually all brain regions examined. 5-HT synthetic rates in patients during migraine attacks did not differ from those of age- and sex-matched controls, whereas they were significantly lower after sumatriptan in a majority of regions. Interictally, global brain 5-HT synthetic rate was slightly, albeit not significantly, lower (-14%) in migraine patients than in controls, with specific cortical areas exhibiting proportionally more severe reductions (-28% to 31%)., Conclusions: These findings point to a low cortical serotonergic tone in migraine patients interictally. Further, they demonstrate widespread increases in brain serotonin (5-HT) synthetic rate in migraine patients during attacks, and that triptans exert a negative feedback regulation of brain 5-HT synthesis concurrently with modulation of pain pathways.

Migraine does not increase the risk for complications of pregnancy for the mother or for the fetus: the incidences of toxemia, miscarriages, abnormal labour, congenital anomalies, and stillbirths are comparable to those of the general population. Several retrospective studies have shown a tendency for migraine to improve with pregnancy. Between 60 and 70% of women either go into remission or improve significantly, mainly during the second and third trimesters. Women with migraine onset at menarche and those with perimenstrual migraine are more likely to go into remission during pregnancy. The migraine type does not seem to be a significant prognostic factor for improvement. However, in the small number of women (4-8%) whose migraines worsen with pregnancy, migraine with aura appears to be overrepresented. In a small number of cases (1.3-16.5%), migraine appears to start with pregnancy, often in the first trimester; these headaches involve a higher proportion of migraine with aura. Management of migraine during pregnancy should first focus on avoiding potential triggers. Consideration should also be given to nonpharmacologic therapies. If pharmacologic treatment becomes necessary, acetaminophen and codeine can be used safely as abortive agents; ASA and NSAIDs (ibuprofen, naproxen) can be used as a second choice, but not for long periods of time, and they should be avoided during the last trimester. For treatment of severe attacks of migraine, chlorpromazine, dimenhydrinate, and diphenhydramine can be used; metoclopramide should be restricted to the third trimester. According to the United States FDA risk categories, meperidine and morphine show no evidence of risk in humans but should not be used at the end of the third trimester. In some refractory cases, dexamethasone or prednisone can be considered. Should prophylactic treatment become indicated, the beta-adrenergic receptor antagonists (e.g., propranolol) can be used.