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Objective: To assess the prevalence and impact of neck pain during headache among respondents with migraine in the multicountry Chronic Migraine Epidemiology and Outcomes – International (CaMEO‐I) Study. Background: Neck pain among individuals with migraine is highly prevalent and contributes to disability. Methods: The CaMEO‐I was a prospective, cross‐sectional, web‐based study conducted in Canada, France, Germany, Japan, United Kingdom, and the United States. A demographically representative sample of participants from each country completed a screening survey to evaluate headache characteristics. Respondents with headache were identified as having migraine or non‐migraine headache based on modified International Classification of Headache Disorders, third edition, criteria; those with migraine completed a detailed survey with migraine‐specific assessments. Results were stratified by the presence or absence of neck pain with headache (NPWH). For these analyses, data were pooled across the six countries. Results: Of 51,969 respondents who reported headache within the past 12 months, 14,492 (27.9%) were classified as having migraine; the remaining 37,477 (72.1%) had non‐migraine headache. Overall, 9896/14,492 (68.3%) of respondents with migraine headache reported NPWH, which was significantly higher (p < 0.001) than the proportion of respondents with non‐migraine headache who reported NPWH (13,536/37,477 [36.1%]). Among respondents with migraine, moderate‐to‐severe disability was significantly more prevalent for those with NPWH versus without (47.7% [4718/9896] vs. 28.9%, p < 0.001). Respondents with NPWH versus without also had significantly greater work productivity losses, at a median (interquartile range [IQR]) of 50.0 (20.0, 71.3) vs. 30.0 (0.0, 60.0) (p < 0.001), lower quality of life (Migraine‐Specific Quality of Life questionnaire version 2.1, median [IQR] Role Function–Restrictive domain score 60.0 [42.9, 74.3] vs. 68.6 [54.3, 82.9], p < 0.001), higher prevalence of depression and anxiety symptoms (depression, 40.2% [3982/9896] vs. 28.2% [1296/4596], p < 0.001); anxiety, 41.2% [4082/9896] vs. 29.2% [1343/4596], p < 0.001), higher prevalence of cutaneous allodynia during headache (54.0% [5345/9896] vs. 36.6% [1681/4596], p < 0.001), and higher prevalence of poor acute treatment optimization (61.1% [5582/9129] vs. 53.3% [2197/4122], p < 0.001). Conclusions: Nearly 70% of respondents with migraine reported NPWH. Individuals with migraine with neck pain during their headaches had greater disability, depression, anxiety, and cutaneous allodynia (during headache) than those without neck pain during their headaches. They also had diminished quality of life and work productivity, and poorer response to acute treatment compared with those without neck pain. Plain Language Summary: We looked at data from a web‐based study of over 51,000 people across Canada, France, Germany, Japan, United Kingdom, and the United States to understand how neck pain affects people with migraine. We found that neck pain is common in people with migraine, and that those who have neck pain during their headaches have more disability, worse symptoms, more anxiety and depression, and poorer quality of life than those without neck pain. Our results show that neck pain is a serious problem for people with migraine, and it can worsen the negative impacts of migraine. [ABSTRACT FROM AUTHOR]

Objective: To describe treatment patterns and direct healthcare costs over 3 years following initiation of standard of care acute and preventive migraine medications in patients with migraine in the United States. Background: There are limited data on long‐term (>1 year) migraine treatments patterns and associated outcomes. Methods: This was a retrospective, observational cohort study using US claims data from the IBM® MarketScan® Research Database (January 2010–December 2017). Adults were included if they had a prescription claim for acute migraine treatments (AMT) or preventive migraine treatments (PMT) in the index period (January 2011–December 2014). The AMT cohort was categorized as persistent, cycled, or added‐on subgroups; the PMT cohort was categorized PMT‐persistent, switched without gaps, or cycled with gaps. Migraine‐specific annual direct costs (2017 US$) across AMT and PMT cohort subgroups were summarized at baseline through 3 years from index (follow‐up). Results: During the index period, 20,778 and 42,259 patients initiated an AMT and a PMT, respectively. At the 3‐year follow‐up, migraine‐specific direct costs were lower in the persistent subgroup relative to the non‐persistent subgroups in both AMT (mean [SD]: $789 [$1741] vs. $2847 [$8149] in the added‐on subgroup and $862 [$5426] for the cycled subgroup) and PMT cohorts (mean [SD]: $1817 [$5892] in the persistent subgroup vs. $4257 [$11,392] in the switched without gaps subgroup and $3269 [$18,540] in the cycled with gaps subgroup). Acute medication overuse was lower in the persistent subgroup (1025/6504 [27.2%]) vs. non‐persistent subgroups (11,236/58,863 [32.2%] in cycled with gaps subgroup and 1431/6504 [39.4%] in the switched without gaps subgroup). Most patients used multiple acute (19,717/20,778 [94.9%]) or preventive (38,494/42,259 [91.1%]) pharmacological therapies over 3 years following treatment initiation. Gaps in preventive therapy were common; an average gap ranged from 85 to 211 days (~3–7 months). Conclusion: Migraine‐specific annual healthcare costs and acute migraine medication overuse remained lowest among patients with persistent AMT and PMT versus non‐persistent treatment. Study findings are limited to the US population. Future studies should compare costs and associated outcomes between newer preventive migraine medications in patients with migraine. Plain Language Summary: Little is known about how patients use medications to acutely treat or prevent migraine over longer periods of time and their associated costs. This study used information from medical and pharmacy claims to understand costs over time for three groups of patients with migraine: (1) those who remained on the same medication for 3 years, (2) those who changed medications, or (3) those who stopped treatment and then changed medications. Results showed that fewer than one in 10 patients stayed on the same medication to treat or prevent migraine over 3 years, but migraine costs and acute migraine medication overuse were lowest in these patients. [ABSTRACT FROM AUTHOR]

The pathophysiological mechanisms underlying migraine are more difficult to investigate in children than in the adult population. Abnormal cortical excitability turns out to be one of the most peculiar aspects of migraine, accounting for the manifestations of migraine attacks. Recently, visual cortical excitability has been explored effectively in adult migraineurs with a technique based on cross-modal audio-visual illusions (with sound-induced flash illusions (SIFIs) being reduced in migraineurs compared to non-migraineur subjects). On such a basis, in this study, we investigated visual cortical excitability in children with migraine using SIFIs using combinations of visual and sound stimuli presented randomly. We evaluated 26 children with migraine without aura and 16 healthy children. Migraineurs did not differ from the age-matched healthy subjects regarding fission or fusion illusions but perceived more flashes in trials of multiple flashes with or without beeps. The higher number of SIFIs in migraineur children compared to adults may be due to a greater propensity of visual stimulation to be driven by auditory stimuli (i.e., acoustic dominance). The increased ability to perceive flashes reveals a hyperfunctional visual cortex, demonstrating that the use of SIFIs is a valid tool for assessing visual cortical responsiveness even in pediatric migraine. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of acceptance and mindfulness‐based interventions on migraine disability, medication use, and attack frequency. Background: Acceptance‐based approaches to headache management are those in which individuals learn to mitigate the influence of pain‐related experiences on their general functioning without controlling pain itself. Treatment approaches include acceptance and commitment therapy (ACT) and mindfulness‐based practices. Both have shown promise in improving broad functioning and disability among individuals with headache. Despite a growing body of research examining acceptance‐based interventions for headache broadly and migraine specifically, no meta‐analytic review of ACT interventions for headache exists, and two meta‐analytic reviews of mindfulness‐based practices yielded conflicting results. Methods: The present study aimed to systematically and quantitatively review the literature related to the efficacy of acceptance‐based interventions among adults with migraine. A multi‐database search (PubMed/MEDLINE, Scopus, PsycINFO, and the Cochrane Central Register of Controlled Trials) identified clinical trials among individuals with migraine that compared structured ACT or mindfulness‐based interventions to control treatment. Random‐effects meta‐analyses were performed using RevMan 5.4 meta‐analytic software, and standardized mean differences (SMD) with 95% confidence intervals (CIs) quantified effect sizes on outcomes of disability, medication use, and headache frequency. Heterogeneity was quantified via I2 index and explored via subgroup analyses. Results: Acceptance‐based interventions yielded significant improvements in disability (SMD = −0.38, 95% CI = −0.56 to −0.20; I2 = 25%, p = 0.20) but not in medication use (SMD = −0.25, 95% CI: −0.57 to 0.06; I2 = 0%, p = 0.82) or headache frequency (SMD = −0.16, 95% CI = −0.37 to 0.05; I2 = 0%, p = 0.73). Conclusion: Results suggest that acceptance‐based interventions are effective in improving disability among adults with migraine and are a viable non‐pharmacological treatment option, in addition to well‐established behavioral migraine management approaches, for patients seeking functional improvement. [ABSTRACT FROM AUTHOR]

Purpose: Previous functional magnetic resonance imaging studies have substantiated changes in multiple brain regions of functional activity in patients with vestibular migraine. However, few studies have assessed functional connectivity within and between specific brain networks in vestibular migraine. Methods: Our study subjects included 37 patients with vestibular migraine and 35 healthy controls, and the quality of magnetic resonance images of all subjects met the requirements. Independent component analysis was performed to identify resting-state networks, and we investigated changes in functional connectivity patterns within and between brain networks. We also used Pearson correlation analysis to assess the relationship between changes in functional connectivity and the clinical features of patients with vestibular migraine. Results: A total of 14 independent components were identified. Compared to healthy controls, patients with vestibular migraine exhibited decreased intra-network functional connectivity in the executive control network and weakened functional connectivity between the anterior default mode network and the ventral attention network, between the anterior default mode network and the salience network, and between the right frontoparietal network and the auditory network. Moreover, the functional connectivity between the salience network and the dorsal attention network was increased. However, the functional connectivity of networks and clinical characteristics of vestibular migraine patients did not demonstrate any significant correlation. Conclusion: In conclusion, our study suggested that patients with vestibular migraine also have abnormal multisensory integration during the interictal period and that the attention network is involved. Changing within- and between-network functional connectivity may indicate that vestibular cortex areas are in a sensitive state. [ABSTRACT FROM AUTHOR]

Background. Migraine is unquestionably a serious cause of dysfunction. Objective. To investigate the prevalence and impact of migraine on the health-related quality of life in Greek nursing students. Methods. Cross-sectional study with 140 nursing students in their 3rd or 4th year of studies. The research tools used were the ID Migraine™ questionnaire, the Migraine Assessment Disability questionnaire, the Medical Outcomes Study questionnaire (SF-36) and a demographics and history of headache form. Results. Self-reported migraine was found to be at 43.6%, self-reported migraine with physician-confirmed diagnosis was at 16.4%, and migraine detected by ID Migraine™ was at 48%. The main trigger factors of migraine were not sleeping at night, fasting for many hours and stress. Males showed a lower degree of migraine-related disability and better mental health. Students with a negative ID Migraine™ had a better health-related quality of life. The self-reported social health score of nursing students was much worse compared to standardized reference scores for the general population in Greece. Conclusions. Preventing migraine and improving students' health-related quality of life should involve a variety of interventions such as psychosocial support and health promotion, stress management, as well as healthy sleeping and eating habits. [ABSTRACT FROM AUTHOR]

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Objective: Migraine and sleep disorders are common health problems in the community and cause loss of labor. There are studies showing that there is a relationship between migraine and sleep quality and these two conditions worsen each other. The aim of this study was to determine the relationship between migraine and sleep quality. Methods: This is a case-control type cross-sectional study consisting of a total of 454 participants, included migraine patients, patients with non-migraine headaches and patients without headache complaint admitted to Family Medicine outpatient clinics between October 2017 and March 2018. Sociodemographic data form, Identity Migraine test, International Headache Society diagnostic criteria questionnaire, Pittsburgh sleep quality scale (PSQI) and Epworth day sleepiness scale (Epw) were applied to the participants by face to face interviews. Results: The total PSQI score was 6.5 ± 3.1, and significantly different between the groups. Patients with diagnosis of migraine had a higher PSQI score and poor sleep quality rate than the control groups. There was no correlation between the frequency of migraine attacks and PSQI scores. Extreme sleepiness in day time for the migraine group (30.7%) was higher than the control groups and there was no correlation between the frequency of migraine attacks and Epw scores. Conclusions: Poor sleep quality and daytime sleepiness rates in migraine patients were higher than those with non-migraine headache patients and patients without headache complaints. This may be due to the fact that migraine is a specific problem affecting sleep or the frequency and severity of headache in the migraine patients are greater than that of the non-migraine headache patients and headache-free participants. [ABSTRACT FROM AUTHOR]

Objective: To examine associations between pre-existing migraines and postconcussion symptoms and cognitive performance acutely (within 72 hours) after a suspected concussion. Design: Nested case-control study. Setting: High schools in Maine, USA. Participants: From a sample of 39161 adolescent athletes who underwent baseline preseason testing, 633 were assessed within 3 days of a suspected concussion. Of these, 59 reported a history of treatment for migraines at baseline (9.3%). These athletes were individually matched to 2 athletes who had a suspected concussion but denied preinjury migraines (total N = 177; age: M = 15.8, SD = 1.3). Assessment of Risk Factors: Self-reported history of treatment for migraines by a physician. Main Outcome Measures: Post-Concussion Symptom Scale total score, ImPACT composite scores, and individual symptom endorsement. Results: Individuals with a pre-existing migraine disorder endorsed greater symptom severity (M = 8.4, SD = 9.9) compared with controls (M = 4.5, SD = 6.5; Cohen's d = 0.47) at preinjury baseline and acutely after suspected injury (migraine: M = 26.0, SD = 25.5; controls: M = 16.7, SD = 15.4; d 5 0.44). Acutely after a suspected concussion, greater proportions of athletes with migraine disorders reported mental fogginess (49.2% vs 33.9%) and memory problems (39.0% vs 24.6%; P < 0.05). Baseline ImPACT composite scores were similar between migraine and control groups (d = 0.04-0.13). Adolescents with pre-existing migraine disorders performed worse after a suspected concussion compared with the control participants on verbal memory (F = 4.32, P = 0.041) and visual memory (F = 3.95, P = 0.049). Conclusions: Individuals with pre-existing migraine disorders may be at higher risk for worse outcomes, including greater overall burden of symptoms and worse cognitive functioning in the memory domain, in the first 72 hours after concussion. [ABSTRACT FROM AUTHOR]

Background: Migraine is the leading cause of days lost due to disability in the world among people less than 50 years of age. There is a paucity of evidence on the impact of migraine and other headache disorders and the cost and productivity losses in the workplace. Methods: Employee population survey assessed prevalence, characteristics, and disability of headache disorders at a Japanese information technology company. This study was supported by the World Health Organization Western Pacific Region Office and International Headache Society. Results: 2458 (1963men, 495 women) out of 2494 responded to the survey that utilized ICHD-3 beta criteria. Among these, 13% (205 male/123 female) had migraine (M), 53% (1093 male/207 female) had tension-type headache (TTH) and 4% (61 male/27 female) had migraine and TTH (M/TTH). The number of days when productivity at work was reduced by half or more because of headache was significantly higher in migraine compared to TTH. The norm-based scoring of SF-12v2 was significantly lower in M/TTH and M than TTH. The economic loss due to absenteeism for migraine was calculated to be $ 238.3US$/year/person for day-off and 90.2US$/year/person for half-day off using migraine disability assessment score (MIDAS). The economic loss due to presenteeism for migraine was calculated to be $ 375.4US$/year/person using MIDAS and 2217US$/year/person using work productivity and activity impairment questionnaire (WPAI). Furthermore, estimated cost of productivity loss associated with presenteeism using WPAI was calculated at 21.3 billion US$/year in Japan as a whole. Conclusions: This study revealed a high prevalence and disease burden among employees with migraine that is associated with substantial losses in productivity and employer cost. These results support the development and implementation of workplace programs to improve migraine management in the workplace and reduce the burden and costs associated with lost workplace productivity. [ABSTRACT FROM AUTHOR]

• C1/C2 hypomobility is an important finding in women with migraine and is related to migraine chronicity. • Mobility of the C1/C2 segment is influenced by neck pain related-disability. • Chronic migraine patients have a reduced global cervical range of motion. To compare flexion rotation test and global active cervical mobility in women with chronic migraine, episodic migraine, and headache-free controls. The influence of neck pain-related disability on the flexion rotation test was also analyzed. Women with chronic migraine (n = 25), episodic migraine (n = 30), and those who were headache-free (n = 30) were evaluated. Upper cervical mobility was measured using the flexion rotation test and global active mobility was assessed using the cervical range of motion device. Neck pain related-disability was assessed using the Neck Disability Index. Statistical analyses were performed using a MANOVA test, prevalence ratios, and linear regression. Chronic (right, MD: −15°; 95%CI: −21° to −11°; left, MD: −13°; 95%CI: −20° to −12°) and episodic (right, MD: −8°; 95%CI: −13° to −4°; left, MD: −8°; 95%CI: −12° to −5°) migraine groups achieved lower flexion rotation test mobility bilaterally than headache-free women. Only chronic migraine was associated with a lower global cervical range of motion compared to that of headache-free women during flexion, (MD: −8°; 95%CI: −15° to −1°), extension (MD: −13°; 95%CI: −20° to −4°), right lateral flexion (MD: −4°; 95%CI: −9° to −0.2°), left lateral flexion (MD: −6°; 95%CI: −10° to −2°), right rotation (MD: −9°; 95%CI: −15° to −4°), and left rotation (MD: −8°; 95%CI: −13° to −2°). Migraine was associated with a 2.85-fold increase in the risk of a positive flexion rotation test. Flexion Rotation Test was influenced by disability-related neck pain (R 2 = 19.1; p = 0.001). Women with migraine have a lower upper cervical range of motion than headache-free women. Women with chronic migraine demonstrated reduced global cervical range of motion when compared to headache-free women. Migraine was associated with in increased likelihood of a positive Flexion Rotation Test. Reduction in mobility was influenced by migraine frequency and disability-related neck pain. [ABSTRACT FROM AUTHOR]

* BACKGROUND: Despite previous evidence, the association between migraines and cervical muscular performance is unclear, * OBJECTIVE: To compare the differences in neck flexor and extensor muscle endurance between women with and without migraine. * METHODS: In this cross-sectional, controlled laboratory study, 26 women with migraine and 26 age-matched women without migraine or headache were assessed using clinical tests of neck flexor and extensor muscle endurance. Holding times were compared between groups using the Mann-Whitney U test for independent samples. * RESULTS: Patients with migraine exhibited a lower holding time for both neck extensor endurance (P = .001) and neck flexor endurance (P<.001) than did the controls. The median neck flexor holding time was 35.0 seconds for the migraine group and 60.5 seconds for the control group. The migraine group held the neck extensor endurance test position for a median of 166.5 seconds compared to 290.5 seconds held by the control group. Both groups reported a similar level of neck pain during the endurance tests (P>.05); however, only individuals in the migraine group reported pain referred to the head during testing. * CONCLUSION: Women with migraine demonstrated decreased neck flexor and extensor endurance compared to women without migraine, which may indicate an association between migraine and reduced performance of the neck muscles. [ABSTRACT FROM AUTHOR]

Background: Migraine has been ranked as third most prevalent disorder and seventh highest cause of disability. Coping up strategy is an emotional, intellectual and behavioural change that will help to deal with stress, and each person has their unique way of coping up. There is scarcity of research in the area of migraine disability and coping strategies acquired by the patients in early adult population. This study is intended to assess correlation between migraine originated disability and coping strategies in early adult female population. Methods: This study is a cross-sectional study with an open ended sample size of 88. Study was conducted in colleges under KAHER, Belagavi. Subjects were given self-report questionnaire for migraine disability and coping strategy. Measurement tools were Migraine Disability Assessment Test and Coping Strategy Inventory. Results: There is a positive significant correlation between migraine disability and few primary scales like cognitive reconstruction, wishful thinking, self-criticism, social withdrawal and secondary scales of coping strategy like problem focussed disengagement and emotional focussed disengagement (p <.05). Conclusions: The result showed that more the person is disabled, more disengaging behaviour from the person/environment is seen. [ABSTRACT FROM AUTHOR]

Background Fast relief of migraine pain, associated symptoms, and migraine-related disability are priorities in the acute treatment of migraine. Efforts to improve the pharmacokinetic profiles of acute migraine treatments with the aim of providing faster relief include the development of non-oral routes of administration. AVP-825 (ONZETRA® Xsail®) is a delivery system containing 22 mg sumatriptan powder that uses a patient's own breath to deliver medication intranasally, targeting the upper posterior nasal cavity beyond the narrow nasal valve, an area lined with vascular mucosa conducive to rapid drug absorption into the systemic circulation. While most studies comparing treatments measure differences in proportions of patients achieving a dichotomous endpoint at fixed time intervals, in this study we compare trajectories of migraine pain and disability over time for AVP-825 versus 100 mg oral sumatriptan tablets. Methods We used data from the COMPASS study (NCT01667679, ), a double-blind, double-dummy, active-comparator, cross-over study of people with a diagnosis of migraine. Participants treated up to five qualifying migraine attacks within 1 hour of onset with either AVP-825 plus placebo tablets or 100 mg oral sumatriptan tablets plus placebo delivery system during the first of two 12-week treatment periods, and then switched treatment sequences to treat up to five more attacks in the second treatment period. Patients recorded ordinal migraine pain intensity and migraine-related disability before dosing (predose), and at 10, 15, 30, 45, 60, 90 and 120 minutes. Three-level ordinal multilevel models accounted for unique data structure (repeated measures nested within attacks for each patient) and tested for treatment differences in migraine pain and migraine-related disability through the first 2 hours of attacks post dose. Results Among 259 study participants (mean age 40.0 years, 84.6% female, 78.4% white), there was significant between and within person variability in migraine pain intensity and migraine-related disability. A typical individual showed significantly faster reductions in migraine pain over the first 30 minutes and migraine-related disability over the first 45 minutes when treating with AVP-825 compared with oral sumatriptan. Overall levels of pain and disability also favored AVP-825 over 2 h following treatment. Model-based odds ratios (OR) comparing AVP-825 to oral sumatriptan ranged from 0.38 to 0.76 for pain and 0.37 to 0.65 for disability, with OR <1 indicating reduced pain/disability in the AVP-825 condition. Conclusions Compared with 100 mg oral sumatriptan, treatment with AVP-825 was associated with faster reductions in migraine pain intensity and migraine-related disability starting at 10 minutes postdose and continuing through the first 30 minutes for migraine pain intensity and the first 45 minutes for migraine-related disability, resulting in lower overall pain intensity and disability that lasted through the first 2 h following treatment. Both migraine pain intensity and disability varied substantially both across subjects and within subjects across attacks. [ABSTRACT FROM AUTHOR]

Objective The purpose of this cross-sectional study was to assess the sociodemographics, disease burden, and treatment patterns of patients with episodic and chronic migraine in the United States. Background Migraine is a disabling neurological disease that places an enormous burden on patients. Methods Data were drawn from the Adelphi Migraine United States Disease Specific Programme (index period: January to March 2014). Physicians ( N = 150) completed a patient report form on 10 consulting patients with migraine. Episodic migraineurs had ≤14 headache days per month (HDM) and those with chronic migraine had ≥15. Headache-related disability was assessed with the Migraine Disability Assessment (MIDAS) questionnaire. Disability was also compared across subgroups based on the number of HDM (≤3, 4-7, 8-14, and ≥15). Results A total of 1487 patient report forms were completed. Over 70% of the patients were female, 90.8% ( n = 1350) were episodic migraineurs, and 9.2% ( n = 137) were chronic migraineurs. Acute treatment was prescribed for >90% of the patients, and >50% had a current prescription for preventive treatment. Despite taking acute and/or preventive treatment, 29.2% of episodic migraineurs (including some patients with ≤3 headache days/month) and 73.2% of chronic migraineurs had moderate-to-severe headache-related disability (MIDAS total score ≥11). Preventive treatment was discontinued/switched at least once by 26.4% of episodic migraineurs and by 53.3% of chronic migraineurs. Of those patients ( n = 382) who gave collective reasons for discontinuation/switching preventive treatment, over 70% selected lack of efficacy and tolerability/safety. Conclusions This real-world analysis provides additional support for the unmet medical need for efficacious therapies that reduce migraine frequency and severity, headache-related disability, and have better tolerability for patients with migraine. In addition, further research is needed to better understand the burden of illness among patients with lower migraine frequency, and to implement treatment strategies to prevent progression of the disease. [ABSTRACT FROM AUTHOR]

Background: Migraine prevalence and disability imprints on Kuwaiti population are underreported. We aimed to measure the prevalence of migraine and to assess its burden in Kuwait. Methods: A cross-sectional community-based study was conducted which included biologically unrelated Kuwaiti adult population aged 18-65 years. They were randomly recruited from all six governments of Kuwait using stratified multistage cluster sampling. Trained interviewers visited the samples in door-to-door approach. The Headache-Attributed Restriction, Disability, and Social Handicap and Impaired Participation (HARDSHIP) questionnaire was used to collect the data. Demographic enquires were followed by diagnostic and disability questions. Results: A total of 15,523 subjects were identified; of whom 3588 (23%) were diagnosed as episodic migraine and 845 (5.4%) as chronic headache. Prevalence of episodic migraine was 31.71% in female versus 14.88% in males ( P < 0.01) with a mean age of 34.56 ± 10.17 years. Most of migraine cohort (64.4%) sought medical advice with respect to their migraine headaches and the majority (62.4%) were seen by general practitioners (GPs) while 17.2% were assessed by neurologists and 3.7% was seen by other specialties. Tension type headache and sinus-related headaches were diagnosed in 8.9% and 2.1% of migraine subjects respectively. The majority (94.6%) of migraine subjects used symptomatic drugs for headache attacks, whereas 39.9% were taking preventive medication. In the preceding 3 months to the survey, subjects with episodic migraine had lost a mean of 1.97 days from their paid work or school attendance compared to 6.62 days in chronic headache sufferers ( P < 0.001). Additionally, subjects with episodic migraine lost a mean of 1.40 days from household work compared to 5.35 days in subjects with chronic headache ( P < 0.001). Participants with episodic migraine and chronic headache missed a mean of 2.81 and 3.85 days on social occasions, in the preceding 3 months ( P < 0.001). Conclusions: Migraine in Kuwait is highly prevalent and it has a significant impact on activity of daily living, schooling/ employment and social occasions of patients. Accurate diagnosis, effective abortive and preventive treatments of migraine are paramount to improve quality of life and as well as cost saving. [ABSTRACT FROM AUTHOR]

Background: Cognitive decline is a major concern in patients with migraine. Depression, anxiety, and/or poor sleep quality are well-known comorbidities of migraine, but available evidence on the subjective cognitive decline (SCD) is limited. This study aimed to investigate the presence and frequency of SCD and its relationship with anxiety, depression and sleep quality in patients with migraine. Methods: We enrolled patients with migraine who scored within the normal range of the Korean-Mini Mental State Examination and the Korean-Montreal Cognitive Assessment. Using the Subjective Cognitive Decline Questionnaire (SCD-Q), participants with ≥7 were assigned to the SCD group. The Headache Impact Test-6, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Pittsburgh Sleep Quality Index were used and analyzed between the two groups. Results: A total of 188 patients with migraine, aged 38.1 ± 9.9 years, were enrolled. The mean SCD-Q score was 6.5 ± 5.5, and 44.7% of participants were identified as SCD. Migraineurs with SCD reported higher headache pain intensity and headache impact, as well as greater prevalence of anxiety, depression, reduced quality of sleep, and shorter sleep duration during weekdays compared to migraineurs without SCD. There were no significant differences in terms of age, sex, migraine type (chronic/episodic), medication, or sleep duration during weekends between the two groups. Upon multivariate logistic analysis adjusted for age, sex, headache characteristics, and psychological variables, depression was associated with increased risk of SCD (Odds ratio 1.31, 95% confidence interval 1.16-1.49) and sleep duration during weekdays was associated with decreased risk of SCD (Odds ratio 0.66, 95% confidence interval 0.44-0.97). Conclusions: A non-negligible number of patients with migraine complained of SCD. Depression and short sleep duration during weekdays were related to SCD among adult migraineurs. [ABSTRACT FROM AUTHOR]

Objective To evaluate the safety and efficacy of a novel solid-state, caloric vestibular stimulation (CVS) device to provide adjuvant therapy for the prevention of episodic migraine in adult migraineurs. Background Migraine causes significant disability in ∼12% of the world population. No current migraine preventive treatment provides full clinical relief, and many exhibit high rates of discontinuation due to adverse events. Thus, new therapeutic options are needed. CVS may be an effective and safe adjuvant-therapy for the prevention of episodic migraine. Methods In a multicenter, parallel-arm, block-randomized, placebo-controlled clinical trial (: NCT01899040), subjects completed a 3-month treatment with the TNM™ device for CVS (refer to Fig. 2 for patient enrollment and allocation). The primary endpoint was the change in monthly migraine days from baseline to the third treatment month. Secondary endpoints were 50% responder rates, change in prescription analgesic usage and difference in total subjective headache-related pain scores. Device safety assessments included evaluation of any impact on mood, cognition, or balance. Results Per-protocol, active-arm subjects showed immediate and continued steady declines in migraine frequency over the treatment period. After 3 months of treatment, active-arm subjects exhibited significantly fewer migraine days (−3.9 ± 0.6 from a baseline burden of 7.7 ± 0.5 migraine days). These improvements were significantly greater than those observed in control subjects (−1.1 ± 0.6 from a baseline burden = 6.9 ± 0.7 migraine days) and represented a therapeutic gain of −2.8 migraine days, CI = −0.9 to −4.7, P = .012. Active arm subjects also reported greater reductions in acute medication usage and monthly pain scores compared to controls. No adverse effects on mood, cognition, or balance were reported. Subjects completed the trial with an average rate of 90% treatment adherence. No serious or unexpected adverse events were recorded. The rate of expected adverse events was similar across the active and the placebo groups, and evaluation confirmed that subject blinding remained intact. Conclusion The TNM™ device for CVS appears to provide a clinically efficacious and highly tolerable adjuvant therapy for the prevention of episodic migraine. [ABSTRACT FROM AUTHOR]

Background Migraine is a common cause of headache in childhood. Several studies have investigated the association between migraine and atopic diseases, mostly in the adult population. Objective This study aimed to investigate this association in children. Methods A case-control study was conducted across 3 European tertiary care hospitals between June 2014 and August 2014. Cases (n = 229) were children aged 6-18 years consulting for a migraine episode. Controls in the same age range (n = 406) were consulting for a minor injury and did not have a history of recurrent headache. Logistic regression analyses tested the effect of atopic diseases and anti-allergic therapies on occurrence of migraine. Results Children with migraine were more likely to have persistent asthma compared to absence of asthma (odds ratio [OR]: 4.57, 95% confidence interval [CI]: 2.04-10.24) and less likely to have been treated by inhaled or nasal corticosteroid (OR: 0.34, 95% CI: 0.15-0.76) or antihistamine therapy (OR: 0.33, 95% CI: 0.18-0.60). The median number of monthly migraine episodes was higher in children with persistent asthma (3; interquartile [IQR]: 1-4; range: 0.5-10) compared to children with intermittent asthma (2; IQR: 1-3; range: 0.1-4) or non-asthmatic children (2; IQR: 1-3; range: 0.1-12) ( P < .01). Conclusion Persistent childhood asthma was associated with increased risk of migraine and higher frequency of migraine attacks. History of anti-asthmatic or anti-allergic therapies was associated with decreased risk of migraine in children and adolescents. The role of these therapies on the pathogenesis and occurrence of migraine needs to be further elucidated because of the huge potential impact in terms of public health. [ABSTRACT FROM AUTHOR]

Objective To describe labor and delivery outcomes in pregnant patients presenting to the hospital setting with an acute severe migraine headache attack earlier in the same gestation. Methods We retrospectively reviewed pregnancy and delivery records from a database of consecutive inpatient neurology consultations for acute headache in pregnant women over a 5 year period. Results We identified 86 pregnant women with acute migraine. The mean age was 29.3 (±6.4) years. Nearly half had migraine with aura (35/86 [40.7%]), 12.8% (12/86) had chronic migraine, and 31.4% (27/86) presented in status migrainosus. Complication rates included 54.7%([41/75], 95% CI 29.87, 52.13) for at least one adverse outcome, 28.0% ([21/75], 95% CI 11.78, 30.22) for preterm delivery, 21.3% ([16/75], 95% CI 7.7, 24.3) for preeclampsia, 30.6% ([23/75] 95% CI 13.48, 32.52) for cesarean delivery, and 18.7% ([14/75] 95% CI 6.15, 21.85) for low birthweight. Conclusions Pregnant women seeking treatment for acute migraine headache experienced a higher rate of preterm delivery, preeclampsia, and low birthweight but a lower rate of cesarean delivery than the local and general populations. More than half (54.7% [41/75] 95% CI 29.87, 52.13) of the study patients experienced some type of adverse birth outcome, suggesting that pregnancies in migraine patients presenting to an acute care setting may benefit from more intense surveillance. [ABSTRACT FROM AUTHOR]

Objective To evaluate the relationships among modifiable psychological factors and chronic migraine and severe migraine-related disability in a clinic-based sample of persons with migraine. Background Evidence evaluating relationships between modifiable psychological factors and chronic migraine and severe migraine-related disability is lacking in people with migraine presenting for routine clinical care. Methods Adults with migraine completed surveys during routinely scheduled visits to a tertiary headache center. Participants completed surveys assessing chronic migraine (meeting criteria for migraine with ≥15 headache days in the past month), severe migraine disability (Migraine Disability Assessment Scale score ≥ 21), and modifiable psychological factors (depressive symptoms [Patient Health Questionnaire-9], anxious symptoms [Generalized Anxiety Disorder-7], Pain Catastrophizing Scale and Headache Specific Locus of Control). Logistic regression evaluated relationships between modifiable psychological factors and chronic migraine and severe migraine disability. Results Among 90 eligible participants the mean age was 45.0 (SD = 12.4); 84.8% were women. One-third (36.0%) met study criteria for chronic migraine; half of participants (51.5%) reported severe migraine-related disability. Higher depressive symptoms (OR = 1.99, 95% CI = 1.11, 3.55) and chance HSLC (OR = 1.85, 95% CI = 1.13, 1.43) were associated with chronic migraine. Higher depressive symptoms (OR = 3.54, 95%CI = 1.49, 8.41), anxiety symptoms (OR = 3.65, 95% CI = 1.65, 8.06), and pain catastrophizing (OR = 1.95, 95% CI = 1.14, 3.35), were associated with severe migraine-related disability. Conclusions Psychiatric symptoms and pain catastrophizing were strongly associated with severe migraine-related disability. Depression and chance locus of control were associated with chronic migraine. This study supports the need for longitudinal observational studies to evaluate the relationships among naturalistic variation in psychological factors, migraine-related disability, and migraine chronification. [ABSTRACT FROM AUTHOR]

Objective To describe the development of the Impact of Migraine on Partners and Adolescent Children (IMPAC) scale. Background Although existing data and clinical experience suggest that the impact of migraine is pervasive and extends beyond the individual with migraine, no validated tools exist for assessing the impact of migraine on the family. Methods The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study is a longitudinal study of people with migraine in the United States. The Family Burden Module (FBM) of the CaMEO Study contained an item pool of 53 questions derived through literature review, clinician input, and patient focus groups pertaining to the following concepts: impact of migraine on family interpersonal relationships, activities, well-being, finances, and health-related quality of life. Respondents with migraine (ie, probands) were categorized into 4 groups based on household composition: migraine probands with partners/spouses and children (M-PC), migraine probands with partners/spouses only (M-P), migraine probands with child(ren) only (M-C), and migraine probands without a partner/spouse or child(ren) (M-O). The IMPAC scale was developed in 3 steps: (1) exploratory factor analysis and item reduction, (2) bifactor analysis, confirmatory factor analysis, and scoring, and (3) reliability and construct validity analyses. Results The analysis of data from 13,064 respondents to the FBM meeting criteria for migraine yielded a 12-item IMPAC scale, with 4 items applying to all of the groups, 4 more items applying to the groups with partners (M-P and M-PC), and 4 additional items to the groups with children (M-C and M-PC). Item responses can be summed and converted into a scoring system assessing mild (<0.5 SD below mean; IMPAC scale Grade I), moderate (0.5 SD below to <0.5 SD above mean; Grade II), severe (0.5-<1.5 SD above mean; Grade III), and very severe (≥0.5 SD above mean; Grade IV) family impact. Test information curves relating to the IMPAC scale for each household type indicated adequate reliability across a large range of family burden severity (from ∼1 SD below to ∼3 SD above mean) and IMPAC scores showed moderate-to-large correlations with other validated tools (range, ± 0.38-0.52), providing support for construct validity. Conclusions We developed a questionnaire to assess family burden attributed to migraine that is brief, robust, and psychometrically sound, with a simple scoring algorithm that can be applied to various household compositions. This questionnaire may be valuable in research settings to provide quantifiable data on the impact of migraine on family dynamics and in clinical settings to facilitate conversations about family burden as a target and a motivation for better treatment. [ABSTRACT FROM AUTHOR]

Background.-The link between arterial thromboembolism and migraine is well-documented; however, few studies investigated the link between venous thromboembolism (VTE) and migraine. We aimed to evaluate the association between migraine and VTE and to examine whether demographics or comorbid risk factors modulate VTE development. Methods.-We conducted a cohort study accessing a nationwide claims-based database with an adult cohort of 102,159 neurologist-diagnosed migraine patients, and 102,159 nonheadache comparison subjects, matched on sex and propensity score for the diagnosis of migraine. Both cohorts were followed until the end of 2010, death, or VTE development. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated based on Cox proportional hazards regression analyses and compared between the two groups. Results.-During a mean follow-up period of 4.2 years, VTE developed in 226 patients (460,047 person-years) in the migraine cohort and in 203 subjects (462,401 person-years) in the comparison cohort. Overall, likelihood of VTE for the migraine cohort did not differ from that in the comparison cohort (aHR 1.12; 95% CI, 0.92-1.35; P = .251). However, subgroup analysis by migraine subtypes ( P = .004 for interaction) revealed an elevated risk of VTE in patients with migraine with aura (aHR 2.42; 95% CI, 1.40-4.19; P = .002), but not in those with migraine without aura. The association was not altered in subsequent subgroup analyses and sensitivity analyses. Conclusions Risk of VTE development is elevated specifically in patients diagnosed with migraine with aura. This association suggests a linked disease mechanism and warrants further exploration. [ABSTRACT FROM AUTHOR]

Background Mig-SCog is a 9-item questionnaire developed to quantify attack-related cognitive complaints in migraine (M). The items relate to executive function and language, and the total Mig-SCog score is the sum of those scales. Objective To evaluate the Mig-SCog scores regarding cognitive symptoms during a variety of conditions. Methods We conducted a prospective comparative study of the Mig-SCog scores (1) between migraine and tension-type headache (TTH) patients during a headache; (2) in migraine patients between migraine attacks, non-headache pain and pain-free status; (3) in migraine patients during and outside a migraine attack. Results One hundred forty-nine patients (98 M and 51 TTHA). Total Mig-SCog score was higher in migraine patients than TTH (8.0 ± 4.1 vs 3.4 ± 3.2, P < .0001). Sixty-three patients took part in the next part of the study. Migraine patients rated the Mig-SCog higher for migraine (7.9 ± 4.6) than for non-headache pain (2.3 ± 2.9, P < .0006) or pain-free (1.6 ± 2.4, P < .0006). In the final phase of the study, 38 patients Mig-SCog scores were not significantly different whether obtained during or outside an M attack ( P = .26). Conclusions Attack-related subjective cognitive symptoms, assessed by Mig-SCog scores, differed between migraine and TTH patients. The Mig-SCog scores from migraine patients were found to be higher during migraine than during non-headache pain or pain-free conditions. Patient scoring from memory for usual attacks was not significantly different to scoring within attacks, We believe this demonstrates negligible recall bias. [ABSTRACT FROM AUTHOR]

Background: Urotensin-II (U-II) is a peptide recognized by its potent vasoconstrictor activity in many vascular events, however the role of urotensin-II in migraine has not been considered yet. The molecular mechanisms and genetics of migraine have not been fully clarified yet, but it is well-known that vascular changes considerably contribute in pathophysiology of migraine and also its complications. The aim of this study was to analyze the plasma U-II levels along with genotype distributions and allele frequencies for UTS2 Thr21Met and Ser89Asn polymorphisms among the patients with migraine without aura (MWoA). Methods: One hundred eighty-six patients with MWoA and 171 healthy individuals were included in this study. Plasma U-II levels were measured in attack free period. The genotype and allele frequencies for the Thr21Met (T21M) and Ser89Asn (S89N) polymorphisms in the UTS2 gene were analyzed. Results: Plasma U-II levels were significantly higher in MWoA patients ( p = 0.002). We detected a significant association between the T21M polymorphism in the UTS2 gene and migraine (53.8 % in patients, 40.4 % in controls, p = 0.035), but not with S89N polymorphism ( p = 0.620). A significant relationship was found between U-II levels and MIDAS score (β = 0.508, p = 0.001). Conclusion: Our study suggests that U-II may play a role in migraine pathogenesis; also Thr21Met polymorphism was associated with the risk of migraine disease. Further studies are needed for considering the role of U-II in migraine pathophysiology and for deciding if UTS2 gene may be a novel candidate gene in migraine cases. [ABSTRACT FROM AUTHOR]

Background Migraine has been associated with mental illness, and may also be associated with increased risk of suicidal behavior. Objective The aim of this article was to examine the association between migraine headache and self-harm and suicide mortality using population-based health administrative data from Ontario, Canada. Methods The sample included 101,114 participants in a population-based health survey in the province of Ontario, Canada, who responded to the survey in 2003, 2005, or 2007, and provided health card numbers for linkage to population-based health administrative data. Participants self-reported a physician diagnosis of migraine headache. Heath administrative data were used to calculate (1) Follow-up time until first presentation to the emergency department for intentional self-harm; (2) Follow-up time until death by suicide. Proportional subdistribution hazards regression was used to compare time until death among those with and without history of migraine, after accounting for competing risks of death and adjusting for confounders. Results Physician diagnosis of migraine was reported by 11.2% of the sample (11,314 individuals). Mean follow-up time was 7.3 years. Emergency department visits for self-harm during the follow-up period were almost 50% more likely in those with migraine (76.4 vs 35.7 per 100,000 person years; adjusted hazard ratio = 1.48; 95%CI: 1.11,1.96). Death by suicide was rare with only 55 suicides in the follow-up period (7.45 per 100,000 person-years). Risk of suicide was similar for both those with and without history of migraine headache (adjusted hazard ratio=0.60; 95%CI: 0.22,1.65). Conclusions Physician diagnosis of migraine headache was found to be prospectively associated with increased risk of deliberate self-harm, but there was no evidence linking it to suicide mortality. Definitively linking migraine to death by suicide may require very large samples. Health care professionals should consider monitoring suicidal risk in individuals with migraine headache. [ABSTRACT FROM AUTHOR]

Background and Objective Symptoms and signs of sensorial disturbances are characteristic features of a migraine headache. Somatosensory temporal discrimination measures the temporal threshold to perceive two separate somaesthetic stimuli as clearly distinct. This study aimed to evaluate somaesthetic perception in migraine patients by measuring the somatosensory temporal discrimination thresholds. Methods The study included 12 migraine patients without aura and 12 volunteers without headache. Somatosensory temporal discrimination threshold (STDT) values were measured in the face (V3) and hands (C7) during a lateralized headache attack and the headache-free interictal period. The disease duration, pain intensity, phonophobia, photophobia, nausea, vomiting, and brush allodynia were also recorded during the migraine attack. Results STDT values were within normal limits and not different between the control group and the interictal period in migraine patients. Compared to the headache-free period, STDT values during the attack were significantly prolonged in the contralateral hand (C7) (155.7 ± 84.2 vs 40.6 ± 16.1 ms [ P < .001]), ipsilateral hand (C7) (88.6 ± 51.3 vs 31.4 ± 14.2 ms [ P < 0.001]), contralateral face (V3) (65.5 ± 35.4 vs 37.6 ± 22.2 ms [ P = .006]) and ipsilateral face (V3) (104.1 ± 44.5 vs 37.5 ± 21.4 ms [ P < 0.001]) according to the lateralization of the headache. Ictal STDT values of the contralateral hand and ipsilateral face were significantly increased compared to that of the ipsilateral hand and contralateral face (155.7 ± 84.2 ms vs 88.6 ± 5.1.3 ms [ P = .001], 104.1 ± 44.5 ms vs 65.5 ± 35.4 ms [ P = 0.001]). No allodynia was detected in the areas that were tested for somatosensory temporal discrimination. The visual analog scale scores were correlated with the somatosensory temporal discrimination thresholds of the contralateral hand ( r = 0.602, P = .038), whereas no correlation was detected between the somatosensory temporal discrimination thresholds and disease duration, brush allodynia in the forehead, phonophobia, photophobia, nausea and vomiting. Conclusion The study demonstrates for the first time that somatosensory temporal discrimination thresholds are elevated during migraine attacks. A transient disruption of the central processing of somaesthetic stimuli during the lateralized migraine attack may provide additional information to understand the mechanisms of the cognitive and sensory perception impairment associated with migraine headache and may have diagnostic value. [ABSTRACT FROM AUTHOR]

Objective/Background Seasonal variation of migraine attack frequency has been described as a phenomenon. We aimed to compare functional disability and the occurrence of cranial autonomic symptoms ( CASs) in patients who reported a seasonal variation in their migraine attack frequency with those who did not. Methods We conducted a questionnaire-based observational study on patients with migraine without aura who visited our institution from January 2005 to December 2013. Patient demographics, headache characteristics, and accompanying symptoms were recorded, and functional disability was evaluated by Migraine Disability Assessment ( MIDAS) Questionnaire. Results Of 4423 patients screened, 769 were eligible for analysis, and 104 (13.5%) of them reported seasonal variation. Several CAS features such as conjunctival injection (25.0% vs 14.0%), lacrimation (20.2% vs 10.8%), eyelid edema (20.2% vs 10.2%), forehead and facial sweating (22.1% vs 11.4%), and ptosis (23.1% vs 11.4%) were more prominent in this subset of patients. They showed higher MIDAS scores (15.4 ± 23.5) than the other migraineurs (10.4 ± 16.9), with a 1.77-fold increased risk (95% confidence interval 1.06-2.96) of severe functional disability ( MIDAS score ≥21) after adjustment for age group, sex, headache frequency, intensity, and duration. The higher the number of CASs, the greater also was the proportion of patients with severe functional disability. Conclusions Patients who reported seasonal variation in migraine also reported more CASs and had more severe functional disability. The profound functional disability in the migraineurs reporting seasonal variation or CAS also provides direction for proactive clinical management in these patients. [ABSTRACT FROM AUTHOR]

Background: Although in the past decade occidental countries have increasingly recognized the personal and societal burden of migraine, it remains poorly understood in Africa. No study has evaluated the impact of sleep disturbances and the quality of life (QOL) in sub-Saharan Africans with migraine. Methods: This was a cross-sectional study evaluating adults, ≥ 18 years of age, attending outpatient clinics in Ethiopia. Standardized questionnaires were utilized to collect demographic, headache, sleep, lifestyle, and QOL characteristics in all participants. Migraine classification was based on International Classification of Headache Disorders (ICHD)-II criteria. The Pittsburgh Sleep Quality Index (PSQI) and the World Health Organization Quality of Life (WHOQOL-BREF) questionnaires were utilized to assess sleep quality and QOL characteristics, respectively. Multivariable logistic regression models were fit to estimate adjusted odds ratio (OR) and 95% confidence intervals (95% CI). Results: Of 1,060 participants, 145 (14%) met ICHD-II criteria for migraine. Approximately three-fifth of the study participants (60.5%) were found to have poor sleep quality. After adjustments, migraineurs had over a two-fold increased odds (OR = 2.24, 95% CI 1.49-3.38) of overall poor sleep quality (PSQI global score >5) as compared with non-migraineurs. Compared with non-migraineurs, migraineurs were also more likely to experience short sleep duration (≤7 hours) (OR = 2.07, 95% CI 1.43-3.00), long sleep latency (≥30 min) (OR = 1.97, 95% CI 1.36-2.85), daytime dysfunction due to sleepiness (OR = 1.51, 95% CI 1.12-2.02), and poor sleep efficiency (<85%) (OR = 1.93, 95% CI 1.31-2.88). Similar to occidental countries, Ethiopian migraineurs reported a reduced QOL as compared to non-migraineurs. Specifically Ethiopian migraineurs were more likely to experience poor physical (OR = 1.56, 95% CI 1.08-2.25) and psychological health (OR = 1.75, 95% CI 1.20-2.56), as well as poor social relationships (OR = 1.56, 95% CI 1.08-2.25), and living environments (OR = 1.41, 95% CI 0.97-2.05) as compared to those without migraine. Conclusion: Similar to occidental countries, migraine is highly prevalent among Ethiopians and is associated with poor sleep quality and a lower QOL. These findings support the need for physicians and policy makers to take action to improve the quality of headache care and access to treatment in Ethiopia. [ABSTRACT FROM AUTHOR]

Background: While headache is a common symptom among brain tumors patients, often patients with common headache have concerns of being at risk for developing brain tumors. We aimed to disprove that migraine or headache in general is associated with increased risk of developing brain tumors. Methods: Prospective study among 39,534 middle-aged women, free of any cancer, and who provided information on headache history at baseline. We followed participants for occurrence of medical record-confirmed brain tumors. We ran multivariable-adjusted Cox proportional hazards models to evaluate associations between any headache, migraine, and non-migraine headache with incident brain tumors. We further evaluated whether migraine frequency and updated headache information during follow-up could be linked with brain tumors. Results: A total of 13,022 (32.9%) women reported headache, of which 5,731 were classified as non-migraine headache and 7,291 as migraine. During a mean follow-up of 15.8 years, 52 brain tumors were confirmed. The multivariable-adjusted hazard ratios (95% confidence interval) for brain tumors were 1.33 (0.76-2.34) for any headache, 1.18 (0.58-2.41) for migraine and 1.53 (0.75-3.12) for non-migraine headache. The association for any headache was further attenuated in time-varying analyses (1.15; 0.58-2.24). Those who experience migraine six times/year were also not at increased risk of brain tumor (0.67; 0.13-3.32). Conclusions: Results of this large, prospective cohort study in women do not provide evidence that headache in general or migraine in particular are associated with the occurrence of brain tumors. Our data should reassure patients with headache that brain tumor is not a long-term consequence of headache. [ABSTRACT FROM AUTHOR]

Background There are only 2 small sample studies investigating allodynia in the pediatric population. The aim of this study was to evaluate the frequency of allodynia during cephalalgic attacks in a juvenile population with primary headaches and its association with other symptoms of migraine. Methods We reviewed all medical records of patients with primary headache consecutively seen during a 2-year period. Frequency of allodynia was evaluated, by means of a questionnaire, consisting of 6 questions (for example: Do you avoid touching your head when you have a migraine attack?). Results Two hundred thirty children suffering from primary headache were seen during the study period. Two hundred two children were affected by migraine, 28 (12.2%) by other primary headaches. Migraineurs significantly more frequently complained of allodynia compared to other primary headaches (37% vs 0%). At multivariate analysis, allodynia was significantly associated with pain aggravated by physical activity (adjusted odds ratio [ ORa ] 2.0, 95% confidence interval [ CI] 1.0, 3.8), phonophobia ( ORa 2.3, 95% CI 1.0, 5.1), and nausea ( ORa 1.9, 95% CI 1.0, 3.7). Conclusion According to our data, allodynia is common during pediatric migraine attacks. The association between allodynia and physical activity, nausea and phonophobia are supported by studies on adult population and suggests specific physiopathological mechanisms. [ABSTRACT FROM AUTHOR]

Background Persistent migraine aura without infarction ( PMA) is a rare condition that is defined as an aura that lasts longer than 1 week in absence of infarction. Two types of PMA have been distinguished, notably persistent primary visual disturbance ( PPVD) and typical aura ( TA). Objectives This case-based review article describes four new cases of PMA as well as reviews all cases reported, trying to identify relevant associations, in particular with respect to functional investigations. Methods We performed a systematic literature search, extending from the period when it was first described (1991) to March 2014. We included all case descriptions of which criteria for PMA formulated in the International Classification of Headache Disorders, second edition, were met. In addition, we described four new cases. Results We identified 47 cases of PMA, 27 PMA-PPVD and 19 PMA-TA. In one case, there was not enough information to define the type of PMA. The mean age of onset was 30 years, varying from 7 to 74 years. The duration of symptoms varied from 9 days to 28 years. Besides a longer duration in symptoms in the PMA-PPVD group, we could not identify any differences between these groups. Some authors report occipital hypoactivity on Tc99m-hexamethylpropylene amine oxime -single-photon emission computed tomography ( Tc99m- HMPAO-SPECT) or fluorodeoxyglucose-positron emission tomography ( FDG-PET) in PMA cases, but data are inconsistent. Multiple drugs have been used for the treatment of PMA, usually with little effect. Lamotrigine seems to be the most effective drug. Conclusion Despite the fact that 47 cases of PMA have been reviewed in this paper, many questions remain. The cases that have been described so far show inconsistent data with respect to the results of functional studies as well as treatment effects. The pathophysiology of PMA is still largely a matter of conjecture. [ABSTRACT FROM AUTHOR]

Objective To assess the relationship between the phenotype of the 'visual snow' syndrome, comorbid migraine, and typical migraine aura on a clinical basis and using functional brain imaging. Background Patients with 'visual snow' suffer from continuous TV-static-like tiny flickering dots in the entire visual field. Most patients describe a syndrome with additional visual symptoms of the following categories: palinopsia ('afterimages' and 'trailing'), entopic phenomena arising from the optic apparatus itself (floaters, blue field entoptic phenomenon, photopsia, self-light of the eye), photophobia, nyctalopia (impaired night vision), as well as the non-visual symptom tinnitus. The high prevalence of migraine and typical migraine aura in this population has led to the assumption that 'visual snow' is caused by persistent migraine aura. Due to the lack of objective measures, alternative diagnoses are malingering or a psychogenic disorder. Methods (1) The prevalence of additional visual symptoms, tinnitus, and comorbid migraine as well as typical migraine aura was assessed in a prospective semi-structured telephone interview of patients with 'visual snow.' Correlations were calculated using standard statistics with P < .05 being considered statistically significant. (2) Areas with increased brain metabolism in a group of 'visual snow' patients in comparison to healthy controls were identified using [18 F]-2-fluoro-2-deoxy-D-glucose positron emission tomography and statistical parametric mapping (SPM8 with whole brain analysis; statistical significance was defined by P < .001 uncorrected for multiple comparisons). Results (1) Of 120 patients with 'visual snow,' 70 patients also had migraine and 37 had typical migraine aura. Having comorbid migraine was associated with an increased likelihood of having palinopsia (odds ratio [ OR] 2.8; P = .04 for 'afterimages' and OR 2.6; P = .01 for 'trailing'), spontaneous photopsia ( OR 2.9; P = .004), photophobia ( OR 3.2; P = .005), nyctalopia ( OR 2.7; P = .01), and tinnitus ( OR 2.9; P = .006). Typical migraine aura was associated with an increased likelihood of spontaneous photopsia ( OR 2.4; P = .04). (2) After adjusting for typical migraine aura, comparison of 17 'visual snow' patients with 17 age and gender matched controls showed brain hypermetabolism in the right lingual gyrus (Montreal Neurological Institute coordinates 16-78-5; kE = 101; ZE = 3.41; P < .001) and the left cerebellar anterior lobe adjacent to the left lingual gyrus (Montreal Neurological Institute coordinates -12-62-9; kE = 152; ZE = 3.28; P = .001). Conclusions -Comorbid migraine aggravates the clinical phenotype of the 'visual snow' syndrome by worsening some of the additional visual symptoms and tinnitus. This might bias studies on 'visual snow' by migraineurs offering study participation more likely than non-migraineurs due to a more severe clinical presentation. The independence of entoptic phenomena from comorbid migraine indicates 'visual snow' is the main determinant. The hypermetabolic lingual gyrus confirms a brain dysfunction in patients with 'visual snow.' The metabolic pattern differs from interictal migraine with some similarities to migrainous photophobia. The findings support the view that 'visual snow,' migraine, and typical migraine aura are distinct syndromes with shared pathophysiological mechanisms that need to be addressed in order to develop rational treatment strategies for this disabling condition. [ABSTRACT FROM AUTHOR]

Objective The aim of this study is to compare daily Pediatric Migraine Disability Assessment ( PedMIDAS)-based scores for headaches occurring on school days vs non-school days and during the school year vs the summer holiday. Background The PedMIDAS is the only instrument validated to assess migraine disability among school-aged children. However, the PedMIDAS may underestimate disability during prolonged school holidays. Methods In a prospective cohort study, migraine patients aged 10-18 years completed a 90-day Internet-based headache diary. For each headache day, they answered PedMIDAS-based questions and rated their headache intensity (scale 1-10). PedMIDAS-based scores, headache intensity ratings, and relative headache frequencies were compared for school days vs non-school days and for the school year vs the summer holiday. Results Fifty-two patients completed 4680 diary entries comprising 984 headache days. The headache frequencies and intensity ratings did not differ between time periods. However, the mean headache disability scores (as measured from PedMIDAS-based questions) were significantly different for school days (0.85) compared to non-school days (0.45), P < .001, and for the school year (0.73) compared to the summer holiday (0.46), P < .016. Conclusion Given similar headache intensities and frequencies, daily PedMIDAS-based scores significantly underestimate headache disability on non-school days. Accordingly, PedMIDAS scoring during the school year may not be comparable to assessments done during the summer holiday. These potential differences must be considered when using the instrument as an outcome measure for clinical trials. [ABSTRACT FROM AUTHOR]

Objective To investigate cervical, interictal reproduction of usual head pain and its effect on the nociceptive blink reflex in migraineurs. Background Anatomical and neurophysiological studies in animals and humans have confirmed functional convergence of trigeminal and cervical afferent pathways. Migraineurs often present with occipital and neck symptoms, and cervical pain is referred to the head in most cases, suggesting that cervical afferent information may contribute to headache. Furthermore, the effectiveness of greater occipital nerve blockade in migraine and demonstrable modulation of trigeminal transmission following greater occipital nerve blockade suggest an important role for cervical afferents in migraine. However, to what extent cervical afferents contribute actively to migraine is still unknown. Methods The passive accessory intervertebral movements of the atlanto-occipital and C2-3 spinal segments of 15 participants (14 females, 1 male; age 24-44 years, mean age 33.3 years) with migraine were examined interictally. During 1 session, either the atlanto-occipital or C2-3 segment was examined, resulting in referred usual head pain, while in another session, pressure was applied over the common extensor origin (lateral epicondyle of the humerus) of the ipsilateral arm. Each intervention was repeated 4 times. The nociceptive blink reflex to a supraorbital electrical stimulus was elicited ipsilaterally during both sessions before and during each intervention. The main outcome variables were the number of recorded blinks, area under the curve and latencies of the R2 components of the nociceptive blink reflex. Participants also rated the intensity of referred head pain and the supraorbital stimulus on a scale of 0-10, where 0 = 'no pain' and 10 = 'intolerable pain,' and rated the intensity of applied pressure where 0 = 'pressure but no pain' and 10 = 'intolerable pain.' Results Participants reported a significant reduction in local tenderness ratings across the 4 trials for the cervical intervention but not for the arm ( P = .005). The cervical intervention evoked head pain in all participants. As the cervical intervention was sustained, head pain decreased significantly from the beginning to the end of each trial ( P = .000) and from the beginning of the first trial to the end of the last ( P = .000). Pain evoked by the supraorbital stimulus was consistent from baseline to across the 4 trials ( P = .635) and was similar for the cervical and arm interventions ( P = .072). The number of blinks decreased significantly across the experiment ( P = .000) and was comparable in the cervical and arm interventions ( P = .624). While the R2 area under the curve decreased irrespective of intervention ( P = .000), this reduction was significantly greater for the cervical intervention than when pressure was applied to the arm ( P = .037). Analysis of the R2 latencies revealed a notable increase across the experiment ( P = .037). However, this increase was significantly greater following the cervical than arm intervention ( P = .012). Conclusions Our findings corroborate previous results related to anatomical and functional convergence of trigeminal and cervical afferent pathways in animals and humans, and suggest that manual cervical modulation of this pathway is of potential benefit in migraine. [ABSTRACT FROM AUTHOR]

Objective To investigate if a headache frequency of 15 days per month constitutes a turning point in the psychosocial impairment associated with migraine. Background Migraine is differentiated into episodic and chronic forms based on a headache frequency criterion (< vs ≥15 headache days per month). It is presently not clear if this criterion represents a clinically and pathophysiologically meaningful turning point of the disease. Methods Six hundred and one migraine patients completed measures of pain-specific disability (Migraine Disability Assessment Scale, von Korff scale), health-related quality of life (Short Form-12 Health Survey), habitual well-being (Marburg questionnaire), and anxiety and depression (Hospital Anxiety and Depression Score). Results A significant increase of psychosocial impairment with the number of headache days per month was found at lower headache frequencies, but leveled off at higher headache frequencies. Visual inspection and spline interpolation suggested that the turning point was not exactly at 15 headache days per month but rather around 13.3 (confidence interval: 8.9-17.7) days. Accordingly, significant correlations between headache days and psychosocial impairment were found in the group with ≤13 headache days per month (Spearman's rho = 0.25, P < .001) but not in the group with >13 headache days (rho = −0.02, n.s.). Conclusion These results suggest that a meaningful turning point in psychosocial impairment associated with migraine is located around 13.3 headache days per month, somewhat below the 15-headache days criterion that by definition separates chronic from episodic migraine. However, confidence intervals surrounding the turning point were large. Further studies will be needed to more exactly localize the turning point. [ABSTRACT FROM AUTHOR]

Objective To determine whether migraine interferes with health-related quality of life ( HRQL) and the degree of disability caused by this condition in the daily life of children of both genders aged 6-12 years. Background Migraine is a chronic disease with recurrent symptoms that lead to a reduction of daily activity during the crises and during the intercritical periods, with an impact on HRQL. Methods The sample consisted of 50 children with migraine without aura being treated at a childhood headache outpatient clinic (study group) and 50 children with no history of headache selected at a pediatric outpatient clinic (control group). The Pediatric Migraine Disability Score questionnaire was applied to the study group in order to determine the disability provoked by headache in daily life, and the Pediatric Quality of Life Inventory4.0 was applied to both groups to determine HRQL. Results Children with migraine were absent from school activities, did not perform household tasks, and did not participate in leisure activities for 23.9 days, on average, during the last 3 months because of migraine. Disability was absent or mild in 38% of the children, whereas 14% showed severe disability. HRQL was similar in both groups regarding self-evaluation, whereas it was perceived as being worse by the parents of children with migraine. Children with migraine had a worse school and emotional quality of life as determined by self-perception. According to the perception of the parents, children with migraine had a worse general, physical, and psychosocial quality of life. Absenteeism from school activities, household tasks, and leisure was not correlated with HRQL. Conclusion Although migraine was a cause of school absenteeism, most of the children with migraine showed little or no disability regarding daily life activities and their quality of life was similar to that of children without headache. [ABSTRACT FROM AUTHOR]

Background Disturbances in sleep are common among migraineurs, particularly those with frequent (ie, chronic) migraine. Examination of specific types of sleep disturbance and behaviors among episodic migraineurs, however, has not been sufficiently explored. Further, few studies have investigated whether sleep disturbance is attributable to comorbid affective symptomatology. Objectives The present case-control study sought to (1) assess sleep quality, daytime sleepiness, and sleep hygiene among a large sample of episodic migraineurs; (2) quantify relations between sleep disturbance and headache-related variables; and (3) determine if these relations remain after accounting for comorbid depression and anxiety. Methods Two hundred ninety-two undergraduate students (69.9% female, mean age = 19.19, standard deviation [ SD] = 3.21 years) completed measures of sleep quality, daytime sleepiness, and sleep hygiene along with well-validated measures of depression and anxiety symptomatology. Those screening positive for migraine were subsequently administered a structured diagnostic interview to verify diagnosis of migraine consistent with the International Classification of Headache Disorders, 2nd edition. Episodic migraineurs and non-migraine controls were compared on the sleep disturbance variables, and among those with migraine, relations with headache frequency, severity, and disability were quantified with linear regression analyses. Results Seventy-eight (26.7%) participants met International Classification of Headache Disorders, 2nd edition criteria for episodic migraine. Compared with participants without migraine, episodic migraineurs reported poorer sleep quality (mean = 8.90 [ SD = 3.39] vs 6.63 [ SD = 3.02], P < .0001), with 85.9% reporting clinically significant poor sleep quality (vs 62.0% of controls). Poor sleep quality was significantly associated with headache frequency and headache-related disability, accounting for proportions of variance (14.8% in frequency and 18.2% in disability, both P ≤ .001) similar to those attributable to depression and anxiety. These relationships remained significant after controlling for these affective symptoms, in which sleep quality accounted for 5.3% and 5.8% of unique variance in frequency and disability, respectively ( P < .05). By comparison, daytime sleepiness and poor sleep hygiene were not consistently associated with migraine or migraine-related variables. Conclusions Consistent with prior studies on chronic migraine, poor sleep quality is uniquely associated with episodic migraine, and this relationship is not solely attributable to comorbid psychiatric symptomatology. Sleep quality should be preferentially assessed (vs sleepiness and sleep hygiene) when subjective self-report measures of insomnia are used in clinical headache settings. Future studies should supplement these findings by evaluating the efficacy of interventions that specifically target sleep quality and insomnia (eg, stimulus control, sleep restriction) among episodic migraineurs. [ABSTRACT FROM AUTHOR]

Conclusion: Our findings suggest that migrainous vertigo (MV) has a substantial vestibulo-spinal abnormality that can be uncovered by posturography. Patients with MV also showed a difficulty in using multisystem information, especially somatosensory information. Caloric and sensory organization tests (SOTs) have complementary roles in assessing vestibulo-ocular and vestibulo-spinal function, particularly for Meniere's disease (MD) and MV. Objectives: To compare vestibular dysfunction through caloric testing and posturography in patients with MV, MD, and acute vestibular neuritis (VN). Methods: Caloric tests and SOTs were performed in 31 patients with MV, 23 with MD, and 37 with VN. The abnormal results in caloric test, SOT conditions, and somatosensory, visual, and vestibular ratios were analyzed. Results: Abnormal canal paresis was found in 7 patients with MV (23%), 11 with MD (48%), and 37 with VN (100%). An abnormal vestibular ratio in SOT was found in 14 patients with MV (45%), 6 with MD (26%), and 23 with VN (62%). In MV, an abnormal vestibular ratio was more common than canal paresis and an abnormal vestibular ratio was more common than in MD. An abnormal somatosensory ratio (19%) in MV was significantly more common than in VN and MD (3% and 0%). For condition 2, MV showed a significantly higher abnormal rate than VN. An abnormal visual ratio in MV was more common than in VN and MD but this was not significant. [ABSTRACT FROM AUTHOR]

Background The impact of migraine on quality of life ( QOL) can be aggravated by other comorbid factors. The aim of the present study was to assess the differences in the QOL of adolescents with chronic migraine, episodic migraine, and healthy adolescents, and whether the differences in QOL among the diagnostic groups were associated with the presence of self-reported psychiatric symptoms, such as depression and anxiety. Methods A total of 157 adolescents (aged 15-19 years old) were included in the study. Fifty patients had episodic migraine, 56 patients suffered from chronic migraine, and 51 healthy adolescents were controls. All of the participants responded to a detailed headache questionnaire, the Medical Outcomes Trust 36-Item Short-form Health Survey, the State-Trait Anxiety Inventory and the Beck Depression Inventory. Results Chronic migraine patients showed a significantly lower QOL than the control subjects in five dimensions of the Medical Outcomes Trust 36-Item Short-form Health Survey, and lower QOL than the episodic migraine patients in four dimensions. High levels of self-reported depressive symptoms were associated with lower QOL in five dimensions and high levels of self-reported anxiety were associated with lower QOL in four dimensions. Conclusions The QOL of adolescent migraine sufferers may be aggravated not only by migraine but also by other factors, such as anxiety and depressive symptoms, which may contribute to the poor QOL in adolescents suffering from migraine. [ABSTRACT FROM AUTHOR]

Objective: In recent studies, a relationship between migraine headaches and post-traumatic stress disorder (PTSD) has been suggested. The clinicians in most of these studies have not diagnosed PTSD; the evaluation has been carried out using screening scales. It has also been asserted that there is a relation between anger and migraine and other chronic painful disorders. This study aimed to search the prevalence of clinically diagnosed post-traumatic stress disorder (PTSD) among migraine patients and the relationship with anger. Method: Sixty consecutive migraine patients directed from neurology clinic and 60 healthy controls having similar features constituted the sample of this study. SCID-I/CV PTSD module and clinician administered posttraumatic stress disorder scale (CAPS) implemented by the clinician were administered to the sample. The sample also filled in the socio-demographic data form and Spielberg's State-Trait Anger-Anger Expression Scale (STAXI). Results: Seventeen persons (28%) in the migraine group and 5 persons (8.3%) in the control group were diagnosed with PTSD. In the migraine group, PTSD was found at a statistically significantly higher level. The trait anger and anger in subscale scores in the migraine group were found statistically significantly higher compared to the control group. In the migraine group, the anger out subscale mean score was statistically significantly higher in the ones with PSTD than the ones without it. A positive correlation was detected between the scores of trait anger and CAPS and a negative correlation between the scores of anger control and CAPS. Conclusion: In migraine patients, PTSD, trait anger and internal anger are higher compared to the healthy ones. In migraine patients diagnosed with PTSD, the external anger has increased. It may be suggested to seek for the trauma experiences in migraine patients and search the efficiency of trauma and anger directed therapies. [ABSTRACT FROM AUTHOR]

Introduction: In recent studies, it has been suggested that there is a relationship between migraine headaches and post-traumatic stress disorder (PTSD). The PTSD has not been diagnosed by a clinician in these studies; the evaluation has been carried out by the screening scales. Besides, it has also been asserted that there was relationship of alexithymia with migraine and other chronic painful disorders. In this study, our aim was to investigate the prevalence of clinically-diagnosed PTSD and alexithymic features among migraine patients. Methods: Sixty consecutive migraine patients sent from neurology clinic and 60 healthy controls having similar features constituted the sample of this study. SCID-I/CV PTSD module and the Clinician-Administered PTSD Scale (CAPS) was administered to the sample. The subjects also filled in the socio-demographic data form and the Toronto Alexithymia Scale (TAS). The level of pain perceived by the migraine patients was evaluated using a Visual Analog Scale (VAS). Results: 17 subjects (28%) in the migraine group and 5 individuals (8.3%) in the control group were diagnosed with PTSD. Hence, PTSD was found to be statistically significantly higher in the migraine group. 25 persons in the migraine group (41.6%) and 12 in the control group (20%) scored above the TAS cutoff score in terms of alexithymic features. Alexithymia was found to be statistically significantly higher in the migraine group). In the migraine group, VAS scores of the ones with PTSD were statistically significantly higher compared to that in ones without PTSD. 94% of the persons diagnosed with PTSD in the migraine group reported that their migraine headaches started after a traumatic experience. In the migraine group, no statistically significant correlation was detected between CAPS and VAS scores in subjects with PTSD. Conclusion: In migraine patients, PTSD and alexithymic features have been found higher than in the healthy controls. Further studies are needed to search whether the practices aimed at treating the PTSD and alexithymic features can contribute to the treatment of migraine headaches or not. [ABSTRACT FROM AUTHOR]

Background Migraine, especially migraine with aura ( MA), appears to be a risk factor for ischemic lesions in the posterior fossa. The clinical relevance of the lesions is uncertain. Accordingly, herein, we identified individuals with MA, migraine without aura ( MO), and without migraine (controls) in order to investigate their balance and mobility. Methods Participants were selected among patients seen in an outpatient headache clinic. Controls had no history of headache. Balance was assessed by measuring the oscillation area using force plates and mobility was assessed with the Timed Up and Go test. Results Of 92 volunteers, 31 had MO (38 ± 10 years), 31 had MA (37 ± 8), and 30 were controls (33 ± 9). Subjects with MA had larger oscillation area (2.5 ± 1.4 cm2 and 3.7 ± 2.9 cm2) relative to those with MO (2.0 ± 1.7 cm2 and 2.1 ± 2.2 cm2, P = .02) and controls (1.5 ± 0.8 cm2 and 1.7 ± 1.2 cm2, P < .001) when standing in the bipodal position, respectively, with opened and closed eyes. MA was different with MO while standing in the unipodal position with eyes opened (right leg 6.7 ± 2.5 cm2 vs 4.9 ± 1.7 cm2, P = .002; left leg 6.5 ± 2.7 cm2 and 4.8 ± 1.4 cm2, P = .008). No differences were seen between MA and MO regarding the Timed Up and Go, although both groups were different than controls (8.5 seconds. and 6.5 seconds, P < .001; 8.2 and 6.5 seconds, P < .01, respectively). Dizziness symptoms happened in 25/31 (80%) of those with MA and 20/31 (65%) with MO, relative to 2/30 (6.5%) in controls ( P < .0001 and P < .001). Conclusion Aura negatively affects static balance and mobility in individuals with migraine. Dizziness is a prevalent symptom in this population. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the auditory brain stem response (ABR) in migrainous vertigo (MV). Methods: Four subjects who met clinical criteria for definite MV and 4 subjects with non-vertiginous migraine (NVM) underwent ABR testing while asymptomatic and within 16 hours of a symptomatic episode. Four control subjects were also tested. A set of 4 consecutive 750-click series was administered at 50-, 60-, and 70-dB intensities. We compared the groups in terms of habituation of the amplitude of wave IV-V (habituation of IV-V) from the first through fourth series for each set. Results: The habituation of IV-V amplitude to 50-dB stimuli was significantly less (p = 0.047) in the symptomatic MV group (5.08% ± 22.32%) than in the symptomatic NVM group (-21.44% ± 13.50%) or the control group (-26.06% ± 9.76%). The habituation of IV-V amplitude to 70-dB stimuli in the MV group was significantly less (p = 0.031) during symptomatic testing (-3.43% ± 8.89%) than during asymptomatic testing (-21.23% ± 6.41%). Conclusions: The habituation of IV-V amplitude is reduced during MV attacks. This finding suggests impaired brain stem inhibition at the level of the inferior colliculus, which shares serotonergic connections with the dorsal raphe nucleus, an area hyperactive in migraine. [ABSTRACT FROM AUTHOR]

A potential association might exist between atherosclerosis and migraine. Carotid intima-media thickness (CIMT) is a marker of generalized atherosclerosis; hence, we aimed to assess CIMT in migraine patients. This study included 30 patients and 60 healthy controls aged between 20 and 40 years. Episodic migraine diagnosis was made according to the criteria of International Headache Society (IHS). Healthy controls who do not suffer any headache problems were selected from among hospital and laboratory staffs. All subjects were evaluated regarding some parameters and features known to be associated with migraine and vascular changes, that is, gender, age, body mass index, blood pressure, cholesterol, smoking habits, used hormonal contraceptives, and history of disease. The left common carotid arteries of the subjects were examined, and CIMT was measured with real-time gray-scale sonography. Mean values and standard deviations were calculated. All measurements were made in migraine-free periods. Migraine patients and control subjects were well matched for those parameters known to be associated with vascular changes, that is, gender, age, BMI, blood pressure, and cholesterol. CIMT values were higher in patients. The results showed that the mean CCA IMT values were 0.493 ± 0.074 mm and 0.409 ± 0.053 mm in migraine patients and controls, respectively ( P < 0.001). There is a relationship between atherosclerosis and inflammation in migraine patients. The risk of cranial inflammatory arteriopathy increases in repeated attacks of migraine. Our study also supports that high number of attacks and attack duration are important in the development of atherosclerosis. [ABSTRACT FROM AUTHOR]

Background While nausea is a defining feature of migraine, the association of nausea with other headache features and its influence on the burden of migraine have not been quantified. Population-based data were used to elucidate the relative frequency and burden of migraine-associated nausea in persons with migraine. Methods Participants with episodic migraine who completed the 2009 American Migraine Prevalence and Prevention survey rated their headache-related nausea as occurring none of the time, rarely,

Objectives and Background.- The possible effects of migraine on executive abilities remain controversial; hence, we studied inter-ictal cognitive performance of individuals with migraine and non migraine headaches (NMH) compared with headache free controls. Design and Method.- In a cross-sectional observational study, taking place in primary care, adults aged 50 or above were evaluated by a neurobehavioral battery including several executive measures. Present history of headache was sought, and migraine was diagnosed by the ID-Migraine questionnaire. The effect of headache type on cognitive measures was analyzed with multiple regression with adjustment by diagnosis, age, gender, education, and depressive symptoms. Results.- Among 478 participants, 23.2% reported current headache, of whom 50 were NMH, and 61 were migraine headaches. No group differences were found in the majority of cognitive measures. Compared with controls, migraine subjects performed worse on a test of attention, while NMH participants presented more intrusions and worse discriminability in memory recognition plus a lower performance on semantic memory tests. Conclusion.- The presence of headaches in late adulthood was related to a worse performance on few measures of executive functioning, suggesting that cognitive impact is not specific to migraine but might be associated to headache. [ABSTRACT FROM AUTHOR]

Objective.- The study aimed to explore the impairment of time perception in migraineurs. Background.- Headache is the most common pain syndrome in middle-aged adults, and migraine is highly prevalent and severely disabling. Although the mechanisms of and the therapies for migraines have long been explored, less is known about the functional impairments associated with them, especially the impairment in time perception, that is, the ability to estimate the passage of time. Methods.- In this study, we used a temporal reproduction task to assess the estimation of the duration of visual stimulus in 27 migraine patients. The stimulus was delivered at different intervals over the milliseconds and seconds range. Results.- In the setting of an interstimulus interval for 1 second and an interstimulus interval for 5 seconds in the 600-millisecond-duration reproduction task, the migraineurs showed impairment in time perception, and in that they significantly overestimated the duration, as compared with the healthy subjects. When compared with the healthy controls for the 3-second and 5-second duration reproduction task, migraineurs in the setting of an interstimulus interval for 1 second and an interstimulus interval for 5 seconds did not show impairment in time perception. Conclusions.- This study indicates that not only is time perception impaired in migraineurs, but that this impairment is exhibited for durations in the milliseconds range, and not the seconds range. [ABSTRACT FROM AUTHOR]

Sex hormones have some implications on headaches. The objective of the study was to investigate the effects of hormonal changes comparatively on tension-type headache (TTH) and migraine, in a population-based sample. A nationwide face-to-face prevalence study was conducted using a structured electronic questionnaire. 54.3 % of the migraineurs reported that the probability of experiencing headache during menstruation was high, whereas 3.9 % had headache only during menstruation. Forward logistic regression analysis revealed that menstruation was a significant trigger for migraine in comparison to TTH. On the other hand, nearly double the number of TTH sufferers reported 'pure menstrual headache' compared to migraineurs ( p = 0.02). Menstrual headaches caused significantly higher MIDAS grades. One-third of the definite migraineurs reported improvement during pregnancy and oral contraceptives significantly worsened migraine. Menopause had a slight improving effect on migraine compared to TTH. Sex hormonal changes have major impacts particularly on migraine; however, the effects of hormonal fluctuations on TTH should not be underestimated. [ABSTRACT FROM AUTHOR]