Search

Background: The Alice in Wonderland Syndrome has been well described in the literature. Along with sensory disturbances, patients notably experience metamorphopsias, or distortions in size (micropsia/macropsia) and distance (teleopsia), particularly of body parts. Some migraineurs, however, report dislocation and disorientation of body parts, which are common features found in paintings of Pablo Picasso. Methods: A 60‐year‐old female with a 20‐year history of chronic migraine presented for evaluation of frequent headaches and visual disturbances. In between her attacks of migraine, she would occasionally notice alterations which she describes as a "Picasso" painting. When looking at people, she would note their ear on top of their head, or their right arm would be short and attached to the face. This would occur 1‐2 times per week and would last 5 to 10 minutes. Inanimate objects, however, would not appear distorted. Results: The available literature, including published works and biographies, suggests Picasso did not suffer from migraine. Nonetheless, careful descriptions taken from migraineurs with visual disturbances may uncover features that resemble his paintings, be it dislocation of limbs with hints of cubism, as reported above, or illusory splitting as has been previously reported. Conclusion: Dislocation or disorientation of body parts as a migraine‐related visual phenomenon is rare and only sparsely reported in the medical literature. Coining of a "Pablo Picasso Syndrome" may better describe this occurrence. [ABSTRACT FROM AUTHOR]

Background: The pathophysiology of vertigo is not fully known; thus, it is difficult to diagnose vestibular migraine (VM) in some migraine patients with vertigo symptoms. Aims/objectives: We aimed to evaluate the diagnostic value of cervical vestibular evoked myogenic potential (cVEMP) in patients with VM. Materials and Methods: Thirty-two patients diagnosed with migraine and 31 patients with VM were prospectively included in this study. The cVEMP responses were obtained, and P1-N1 latency, interpeak amplitude, amplitude asymmetry ratio were calculated. The patients' demographics, results of physical and audiometric examinations, and VEMP records as well as absence of responses were evaluated and compared between groups. Results: The incidence of ears with absence VEMP responses was found to be numerically higher in the migraine group than in the VM group (p =.106). Additionally, there were no statistically significant differences detected between the groups in terms of the p13 or n23 latency, interpeak amplitude, and amplitude asymmetry ratio measured in both right and left ears (p >.05). Conclusions: The increased rate of absent VEMPs was associated with the hypoperfusion of the sacculo-collic reflex pathway in migraine patients. In addition, it was concluded that VEMP reflex responses appear to be insufficient to differentiate between VM and migraine diagnoses. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the possible relationship between sleep disturbances and primary headaches. Methods: This prospective study was carried out in a random group of patients with active primary headaches (case group) and a control group. Patients with active primary headaches were further stratified into two groups: patients with migraine and patients with tension-type headache (TTH). Participants were questioned using the following standardized tests: Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Berlin Sleep Apnea Questionnaire (BSAQ), and a custom-made headache questionnaire. The results of the questionnaires were compared among patients with TTH, patients with migraine, and age- and sex-matched controls. Results: Of the 143 participants, 22.4% had TTH, 30.8% were diagnosed with migraine, and 46.9% did not have a diagnosed headache disorder. Patients with TTH were more likely to have insomnia (ISI score > 7) than patients with migraine (75% vs 50%, respectively) or controls (75% vs 37.3%, respectively) (P = .002). Frequency of poor sleep quality (global PSQI score ≥ 6) was significantly highest in the TTH group (87.5%), while the migraine and control groups had better sleep quality (47.7% and 43.3%, respectively) (P = .0001). TTH patients were more likely to have insufficient sleep (sleep efficiency < 85%) (53.1%) than those with migraine (25%) or the control group (29.9%) (P = .025). Conclusion: Patients who suffered from TTH were more likely to have insomnia than patients with migraine or controls. Nearly all patients with TTH had poor sleep quality, which was also observed in approximately half of the individuals in the migraine and control groups. Three-quarters of patients in the TTH group and more than half in the migraine group indicated inadequate sleep as a trigger factor for headache. [ABSTRACT FROM AUTHOR]

Objectives: Dementia is the most common neurological disease in older adults; headaches, including migraines, are the most common neurological disorder across all ages. The objective of this study was to explore the relationship between migraines and dementia, including Alzheimer's disease (AD) and vascular dementia (VaD).Methods: Analyses were based on 679 community-dwelling participants 65+ years from the Manitoba Study of Health and Aging, a population-based, prospective cohort study. Participants screened as cognitively intact at baseline had complete data on migraine history and all covariates at baseline and were assessed for cognitive outcomes (all-cause dementia, AD, and VaD) 5 years later. The association of exposure (lifetime history of migraines), confounding (age, gender, education, and depression), and intervening variables (hypertension, myocardial infarction, other heart conditions, stroke, and diabetes) with all-cause dementia and dementia subtypes (AD and VaD) was assessed using multiple logistic regression models.Results: A history of migraines was significantly associated with both all-cause dementia (odds ratio [OR]=2.97; 95% confidence interval [CI]=1.25-6.61) and AD (OR=4.22; 95% CI=1.59-10.42), even after adjustment for confounding and intervening variables. Migraines were not significantly associated with VaD either before (OR=1.83; 95% CI=0.39-8.52) or after (OR=1.52; 95% CI=0.20-7.23) such adjustment.Conclusions: Migraines were a significant risk factor for AD and all-cause dementia. Despite the vascular mechanisms involved in migraine physiology, migraines were not significantly associated with VaD in this study. Recognition of the long-term detrimental consequences of migraines for AD and dementia has implications for migraine management, as well as for our understanding of AD etiology. [ABSTRACT FROM AUTHOR]

Background: It is unknown whether clinical parameters differ between migraineurs with and without first‐degree family members with migraine. Objectives: The present cross‐sectional study describes differences between familial and sporadic migraine with a focus on migraine characteristics, migraine severity, comorbidities, and treatment. Method: From the Danish Headache Center we recruited 358 patients with familial migraine and 1727 patients with sporadic migraine. Each participant was assessed using a validated semi‐structured interview. Results: No differences in age (Mean = 44 and 44 [SD = 12.28 and 12.58] for familial and sporadic migraineurs, respectively; P = .900) or sex (295/358 (82.4%) and 1413/1727 (81.8%) women in familial and sporadic migraineurs, respectively; P = .853) were found. Familial migraineurs had more aphasic aura than sporadic migraineurs (41% vs 27%, P = .001). Sporadic migraineurs had more lifetime attacks ie, >100 attacks (45% vs 70%, P < .001) and prolonged attacks ie, lasting >72 hours (5% vs 12%, P < .001) than familial migraineurs. Further, sporadic migraineurs had a higher incidence of concussions (37% vs 41%, P = .001) compared to familial migraineurs. In agreement with a previous study, there was no difference between familial and sporadic migraine regarding triptan response (84% vs 81%, P = .440). Conclusion: Headache characteristics, triptan response, and comorbidities where similar in individulas with and without inherited migraine, suggesting that migraine are to be considered a hmogenoues disease. The difference in the clinical presentation of migraine with aura symptoms among patients with familial migraine should be considered in future studies. Further, more severe migraine among patients with sporadic migraine with aura could suggest that sporadic migraineurs have been exposed to stronger or multiple environmental factors and indicate that an early intervention in migraine treatment could lessen the severity of migraine. [ABSTRACT FROM AUTHOR]

Objective Studies have shown a relationship between insulin resistance (IR) and migraine that is more evident in some migraineurs. Long-term use of various drugs and increased risk of diverse side effects is an unavoidable reality in this population of patients. Thus, in this study, we aimed to investigate factors associated with IR in migraine and the impact of chronic usage of various drugs, which might play a part in development of IR. Design Cross-sectional study. Setting Gebze Fatih General Hospital, Kocaeli, Turkey. Subjects Migraine patients (N = 150) were investigated. Methods Weight, height, waist circumference, and blood pressure were measured. Fasting glucose, fasting insulin, glycated hemoglobin, and lipid profile were also measured. IR was selected as a dependent variable. The independent variables included age, cigarette smoking, alcohol consumption, family history of migraine, diabetes mellitus and hypertension, characteristics of pain, migraine triggers and subgroups, medication used during attack treatment, medication used as prophylactic treatment, and oral contraceptive treatment. Descriptive analysis and multivariate logistic regression were performed. Results Central obesity (odds ratio [OR] = 7.131, 95% confidence interval [CI] = 2.451–20.741, P  < 0.0001), metoclopramide treatment during an attack (OR = 3.645, 95% CI = 0.996–13.346, P  = 0.041), family history of DM (OR = 3.109, 95% CI = 1.189–8.132, P  = 0.035), nonsteroidal anti-inflammatory drug (NSAID) usage during an attack (OR = 2.578, 95% CI = 1.053–6.311, P  = 0.043), and negative family history of hypertension (OR = 0.226, 95% CI = 0.085–0.602, P  = 0.002) were significant factors for exhibiting IR in migraine. Conclusions Our study demonstrates an association between metoclopramide and NSAID treatments and IR in migraine. [ABSTRACT FROM AUTHOR]

Objectives: To characterize unmet treatment needs in a sample of Migraine in America Symptoms and Treatment (MAST) Study participants using oral, acute prescription migraine medications. Background: The MAST Study is a 2017 study of US adults with migraine that profiles current treatment patterns and identifies and quantifies unmet treatment needs. Methods: Cross‐sectional data from an online survey of US adults meeting ICHD‐3 beta criteria for migraine. For inclusion in this paper, respondents self‐reported a history of 3 or more monthly headache days (MHDs) in the past 3 months and at least 1 MHD in the past 30 days, and current use of orally administered acute prescription medication for headache. Three domains of unmet need were identified: inadequate treatment response (ie, inadequate 2‐hour pain freedom, recurrence within 24 hours of initial relief), demanding attack characteristics (rapid onset of attack, headache associated with sleep), and unique patient characteristics (opioid or barbiturate overuse, cardiovascular comorbidity). Sociodemographics, oral medication use, and coexisting conditions and symptoms (ie, level of treatment optimization, psychological symptoms, attack‐related cutaneous allodynia, and migraine symptom severity) were assessed for each domain and by the number of unmet need domains. Results: Overall, 15,133 respondents met inclusion criteria, 26.0% (3930/15,133) reported current use of oral acute prescription medication to treat headache. Eligible participants had a mean age of 45.0 years, 73.6% [2892/3930] were women and 81.1% [3186/3930]) were White. A total of 95.8% (3765/3930) of respondents had at least 1 unmet acute treatment need; 89.5% (3516/3930) reported demanding attack characteristics, 74.1% (2912/3930) reported inadequate treatment response, and 16.1% (634/3930) presented with unique patient characteristics. Common areas of unmet need were rapid headache onset (65.3% [2567/3930]), moderate to severe disability (55.6% [2187/3930]), inadequate 2‐hours pain freedom (49.0% [1892/3930]), and headache recurrence within 24 hours (38.0% [1493/3930]). An increasing number of unmet treatment need domains was associated with worsening psychological symptoms, attack‐related cutaneous allodynia and migraine symptom severity. Conclusion: Nearly all MAST Study respondents using acute oral prescription medications for migraine reported at least 1 unmet treatment need. As unmet needs increased, so did coexisting conditions and symptom severity. [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]

Migraine is a prevalent disorder, affecting 15.1% of the world's population. In most cases, the migraine attacks are sporadic; however, some individuals experience a gradual increase in attack frequency over time, and up to 2% of the general population develop chronic migraine. The mechanisms underlying this chronicity are unresolved but are hypothesized to involve a degree of inflammation. In this article, we review the relevant literature related to inflammation and migraine, from the initiation of attacks to chronification. We propose that the increase in migraine frequency leading to chronic migraine involves neurogenic neuroinflammation, possibly entailing increased expression of cytokines via activation of protein kinases in neurons and glial cells of the trigeminovascular system. We present evidence from preclinical research that supports this view and discuss the implications for migraine therapy. [ABSTRACT FROM AUTHOR]

Objective: We evaluated the frequency of six commonly reported adult migraine premonitory symptoms in children and adolescents with episodic and chronic migraine and elicited psychological or behavioral comorbidities that may be associated with these symptoms.Background: Premonitory symptoms are commonly reported in the adult migraine population; however, little information is available for the pediatric population.Methods: Data were collected on new patients being evaluated in our multidisciplinary pediatric headache clinic over a six-month time interval. The data collected from patients diagnosed with migraine were then reviewed for the following premonitory symptoms: yawning, neck stiffness, fatigue, increased urination, mood changes, and food cravings. History was obtained regarding the frequency of headaches and other associated behavioral or psychological problems.Results: A total of 176 patients were enrolled over a six-month interval, ranging in age from four to 18 years (mean age 12 years); 64% were female, and 42% (74 of 176) of the subjects had at least one premonitory symptom. Patients with migraine with aura were noted to have a significantly higher association with premonitory symptoms (59%, 30 of 51) (P < 0.05). Anxiety disorder was also significantly associated with premonitory symptoms (55%, 11 of 20) (P < 0.05). Fatigue and mood changes were the most commonly reported premonitory symptoms.Conclusions: Premonitory symptoms occurred frequently in our population of pediatric patients with migraine. Fatigue and mood changes were the most frequent symptoms. There were no significant differences in premonitory symptoms by gender or age group (less than 12 years versus greater than 12 years). Anxiety and migraine with aura were correlated with an increased likelihood of premonitory symptoms. [ABSTRACT FROM AUTHOR]

Background: Infant colic, or excessive crying in an otherwise healthy infant, is common, although the cause(s) are not known. This study aimed to determine whether parental migraine is associated with infant colic. Methods: This was a cross‐sectional online survey study of biological parents of 4‐8 week olds in the United States during February and March 2017 and October 2017‐April 2018. Parents self‐reported information about their and their infant's health using validated instruments wherever possible. Parents were recruited using social media advertisements and completed the survey online. Migraine was identified with a validated screener using modified International Classification of Headache Disorders 3rd edition criteria. Parental depression and anxiety were screened with the Patient Health Questionnaire‐2 (PHQ‐2) and Generalized Anxiety Disorder Scale‐2 (GAD‐2). Parental seasonal allergies and asthma were assessed by self‐report. Infant colic was determined based on parental response to the question, "Has your baby cried for at least 3 hours on at least 3 days in the last week?" Results: A total of 1,715 surveys were completed over 2 recruitment periods; 1,419 formed the analysis set. Eight hundred twenty‐seven were completed by biological mothers and 592 by biological fathers. Mean (SD) maternal age: 28.9 (5.1) years; 33.5% had migraine/probable migraine. Maternal migraine was associated with increased odds of infant colic: OR 1.7 (1.3‐2.4). Among mothers with migraine, headache frequency ≥15 days/month was associated with higher risk of infant colic (OR 2.5 (1.2‐5.3)); and anxiety was borderline associated (OR 1.7 (1.0‐2.9)). Mean (SD) paternal age was 31.6 (4.5) years; 20.8% had migraine/probable migraine. Paternal migraine was not associated with infant colic: OR 1.0 (0.7‐1.5). Fathers with depression (OR 2.4 (1.4‐4.3)) or anxiety (OR 1.7 (1.1‐2.7)) were more likely to have a baby with colic but having a girl infant was protective: (OR 0.7 (0.5‐0.97)). Conclusions: Mothers with migraine are more likely to have a baby with colic, while fathers with migraine are not. Further research is needed to determine the mechanisms underlying these findings. In the meantime, clinicians may wish to counsel parents with a maternal history of migraine about the increased possibility of having a colicky infant and provide resources and education about infant crying. [ABSTRACT FROM AUTHOR]

Background: Consistency of response across multiple attacks is typically measured as the proportion of study participants who achieve a categorical endpoint over a specified number of attacks (ie, 2‐hour pain‐free response in 2 of 3 attacks). We applied a novel analytic approach for measuring consistency of response in the acute treatment of episodic migraine using data from the COMPASS study. Methods: The COMPASS study (NCT01667679) was a multiple attack crossover study which compared AVP‐825, a Breath Powered® intranasal delivery system for low‐dose sumatriptan powder (22 mg), with 100‐mg oral sumatriptan tablets in the acute treatment of migraine. Participants were 18–65 years old, met ICHD‐2 criteria for migraine with or without aura, and had migraine for ≥1 year prior to screening. They were instructed to treat up to 5 migraine attacks with each treatment and recorded migraine pain intensity and disability data at pre‐dose and 10, 15, 30, 45, 60, 90, and 120 minutes post‐dose for each attack. We explored the mean level and within‐person variability (WPV; a measure of consistency) in migraine pain intensity and migraine‐related disability across multiple attacks after treatment with AVP‐825 (22 mg) vs oral sumatriptan (100 mg) using location scale mixed‐effects models (LSMEMs). LSMEMs controlled for pre‐dose pain/disability, demographics, treatment sequence, and treatment period. Results: The mean age was 40 and the sample was 84.6% women. Participants (N = 259) treated an average of 6.8 attacks each during the course of the study. Attacks treated with AVP‐825 showed significantly lower mean pain intensity and mean disability from 10 to 90 minutes post‐dose (effect sizes ranged from −0.09 to −0.29 and P values ranged from P <.0001 to P =.01). WPV was significantly greater at 10–15 minutes (WPV ratios ranged from 1.20 to 1.58 and P values ranged from P <.0001 to P =.04) but significantly reduced from 45 to 120 minutes for attacks treated with AVP‐825 compared to oral sumatriptan (WPV ratios ranged from 0.67 to 0.81 and P values ranged from P <.0001 to P =.03). Conclusions: LSMEMs demonstrate that treatment with AVP‐825 is associated with lower average migraine pain intensity and disability from 10 to 90 minutes and greater within‐person consistency across multiple migraine attacks (reduced WPV) from 45 to 120 minutes post‐dose compared to oral sumatriptan. These findings may reflect the more rapid and consistent absorption of sumatriptan using AVP‐825. Increased WPV with AVP‐825 in the first 15 minutes likely reflects the earlier onset of treatment effects with the device compared to oral sumatriptan. LSMEMs show promise as a novel approach for assessing and comparing consistency of treatment response in migraine trials. [ABSTRACT FROM AUTHOR]

Background: Migraine is a common cause of primary headache, with women being affected thrice as common as men. Very few studies are available on sexual dysfunction in female migraineurs. There are no published studies done on the same in India till now. This study was done to look for the prevalence and predictors of sexual dysfunction disorder in females suffering from migraine. Materials and Methods: This is a cross-sectional study done to look for the prevalence and predictors of female sexual dysfunction in migraine. Sixty female patients with migraine were studied. The International Headache Society's International Classification of Headache Disorders, 3rd Edition, was followed to diagnose migraine with or without aura. Migraine disability assessment scale was used to assess migraine-related disability, and Female Sexual Function Index (FSFI) score was used to assess female sexual function. Results: Sexual dysfunction was found in 78.3% migraineurs. The mean FSFI score was 23.1 ± 4.76. The FSFI scores in all the domains were lower in the individuals studied. Acute headaches resulted in loss of sexual desire among all the migraineurs. Conclusion: Sexual dysfunction is common in migraine with all domains of sexual function being affected. There is a significant negative correlation of sexual function with duration of acute episodes of headache and increasing frequency of migraine attacks per month. [ABSTRACT FROM AUTHOR]

Objective: Dizziness is frequently reported in patients with migraine. However, its assessment is often neglected in clinical practice. We investigated the dizziness handicap experienced by patients with migraine and its contributing factors. Methods: A total of 361 migraine outpatients (270 women, 91 men; mean age 39.01 ± 11.2 years) were given the Korean Dizziness Handicap Inventory (KDHI) questionnaire (total score: 100 points; cutoff: 29). The Headache Impact Test, Generalized Anxiety Disorder‐7, Patient Health Questionnaire‐9, and Pittsburgh Sleep Quality Index were also administered. Clinical data such as age, sex, number of headache attacks per month, pain intensity on the visual analog scale, and average sleep hours were collected to find contributing factors. Comparisons were made between chronic and episodic migraine. Results: A total of 153 patients were classified as having dizziness handicap (M+DH) and 208 had migraine without dizziness handicap (M‐DH). Patients with M+DH experienced more headache attacks per month than patients with M‐DH (P = 0.010). The proportion of patients with chronic migraine was larger in the M+DH group (29.4% vs. 17.3%, P = 0.006). Patients with M+DH showed higher scores than patients with M‐DH in all the KDHI subscales. Multivariable logistic regression showed headache impact, pain intensity, anxiety, and depression to be significantly associated with dizziness handicap. Conclusion: The data suggest that patients with migraine, especially those with chronic‐type migraine, experience physical, emotional, and functional handicaps due to dizziness. Dizziness handicap is related to headache impact, anxiety, and depression. Targeted management of such factors is required to reduce the severity of subjective discomfort. [ABSTRACT FROM AUTHOR]

Background: Cutaneous allodynia is a common clinical feature of migraine that has been associated with reduced efficacy of acute migraine treatments and an increased risk of disease progression.Objective: Identify factors associated with allodynia in a sample of adults with migraine.Methods: An online survey panel was used to identify adults with migraine who averaged at least 1 monthly headache day over the previous 3 months. Data on sociodemographics, headache frequency, headache pain intensity, migraine symptom severity, medication use, depression and anxiety, and cutaneous allodynia (via the Allodynia Symptom Checklist) were obtained. Binary logistic modeling predicted the presence of allodynia. Odds ratios and 95% confidence intervals (CI) were calculated.Results: In total, 15,133 individuals with migraine met the eligibility criteria. Mean age was 43.1 years, 73.0% were female, and 81.0% were Caucasian. Allodynia was present in 39.9%. The fully adjusted model, controlling for sociodemographics and headache features, demonstrated that allodynia was significantly associated with a higher migraine symptom severity score (odds ratio 1.17, confidence interval 1.15, 1.19) and more severe pain intensity (odds ratio 1.11, confidence interval 1.08, 1.14); probable depression and/or anxiety (odds ratio 1.83, confidence interval 1.67, 2.00); and overuse of acute medication (odds ratio 1.23, confidence interval 1.09, 1.38). A higher number of monthly headache days increased the likelihood of allodynia, but the effect was attenuated in the fully adjusted model.Conclusion: In a representative sample of US adults with migraine, there were significant associations between allodynia and headache frequency and intensity, anxiety and/or depression, symptom severity, and acute medication overuse. [ABSTRACT FROM AUTHOR]

Background: Prevalence of migraine is high during the reproductive age. Although migraine often improves during pregnancy, the risk of adverse pregnancy, birth, neonatal, and neurological outcomes in mother and offspring remains poorly understood. Objective: To investigate the associations between maternal migraine and risks of adverse pregnancy outcomes in the mother, and birth, neonatal and postnatal outcomes in the offspring. Methods: We used Danish population registries to assemble a cohort of pregnancies among women with migraine and an age‐ and conception year‐matched comparison cohort of pregnancies among women without migraine. The study period was 2005‐2012. We computed adjusted prevalence ratios (aPRs) for pregnancy and birth outcomes and adjusted risk ratios (aRRs) for neonatal and postnatal outcomes, adjusting for age, preconception medical history, and preconception reproductive history. Results: We identified 22,841 pregnancies among women with migraine and 228,324 matched pregnancies among women without migraine. Migraine was associated with an increased risk of pregnancy‐associated hypertension disorders (aPR: 1.50 [95% confidence interval (CI): 1.39‐1.61]) and miscarriage (aPR: 1.10 [95% CI: 1.05‐1.15]). Migraine was associated with an increased prevalence of low birth weight (aPR: 1.14 [95% CI: 1.06‐1.23]), preterm birth (aPR: 1.21 [95% CI: 1.13‐1.30]) and cesarean delivery (aPR: 1.20 [95% CI: 1.15‐1.25]), but not of small for gestational age offspring (aPR: 0.94 [95% CI: 0.88‐0.99]) and birth defects (aPR: 1.01 [95% CI: 0.93‐1.09]). Offspring prenatally exposed to maternal migraine had elevated risks of several outcomes in the neonatal and postnatal period, including intensive care unit admission (aRR: 1.22 [95% CI: 1.03‐1.45]), hospitalization (aRR: 1.12 [95% CI: 1.06‐1.18]), dispensed prescriptions (aRR: 1.34 [95% CI: 1.24‐1.45]), respiratory distress syndrome (aRR: 1.20 [95% CI: 1.02‐1.42]), and febrile seizures (aRR: 1.27 [95% CI: 1.03‐1.57), but not of death (aRR: 0.67 [95% CI: 0.43‐1.04]) and cerebral palsy (aRR: 1.00 [95% CI: 0.51‐1.94]). Conclusions: Women with migraine and their offspring have greater risks of several adverse pregnancy outcomes than women without migraine. [ABSTRACT FROM AUTHOR]

Objective: To explore the neuropsychological correlates and implications of familial hemiplegic migraines (FHMs). Background: FMH is a rare, autosomal dominant subtype of migraine that only occurs in 0.01% of the population. Little is known about the neuropsychological impact of FHMs; however, cognitive impairment associated with cerebellar syndrome has been identified in some cases. Method: A single case study involving a 24‐year‐old male who recently endured an atypical, prolonged FHM episode. Results: The patient's overall neuropsychological functioning was intact with low average semantic fluency and processing speed, and mild indications of executive dysfunction. Conclusion: Baseline and serial neuropsychological testing in individuals with FHM may help identify the potential progression and course of cognitive impairment associated with this condition. [ABSTRACT FROM AUTHOR]

This article aims to provide a concise, high-level overview of the classification, management and treatment of migraine. Migraine is a common, debilitating neurological disorder that is characterised by the presence of severe headaches, which may last anything from a few hours to a few days (4-72 hours). Thus, the condition is characterised by episodes of severe migraine headache, frequently accompanied by nausea and vomiting. These headaches may be unilateral or bilateral and patients may also experience a range of associated features. Acute attacks require rapid, abortive treatment and the rate of recurrence needs to be reduced and managed through the use of effective prophylactic measures. [ABSTRACT FROM AUTHOR]

Objectives: The aim was to evaluate the association of self-perceived levels of attention deficit and hyperactivity symptoms with non-migraine and migraine headaches among university students. We also evaluated their association with migraine aura.Methods: Study subjects were all participants in the internet-based Students Health Research Enterprise. Scores were built to evaluate global attention and hyperactivity symptom levels, self-perceived attention deficit levels and self-perceived hyperactivity symptom levels based on the Adult Attention Deficit and Hyperactivity Disorder Self-Report Scale (ASRS v1.1.). We used standardised questions to classify headache and group participants into "no headache," "non-migraine headache," "migraine without aura" or "migraine with aura".Results: A total of 4816 students were included (mean age 20.3 ± 2.8 years; 75.5% women). Compared with participants without headache, we found significant associations between global ADHD scores and migraine. Students in the highest quintile of global ASRS scores had adjusted odds ratio (aOR) of 1.95 (95% CI 1.56-2.45) when compared to the lowest. This association was mainly driven by an association between self-perceived hyperactivity and migraine with aura. The aOR for migraine with aura was 2.83 (95% CI 2.23-3.61) for students in the highest quintile of hyperactivity. No significant association was found for any attention and hyperactivity symptom level measure and non-migraine headache and between self-perceived levels of attention deficit and migraine.Conclusions: Among students in higher education in France, self-perceived levels of attention deficit and hyperactivity symptoms were selectively associated with migraine. The association was strongest for the hyperactivity domain and migraine with aura. [ABSTRACT FROM AUTHOR]

Background and Objective: Some individuals with migraine report the presence of speech changes during their migraine attacks. The goal of this study was to compare objective features of speech during the migraine pre-attack, the migraine attack, and during the interictal period.Methods: This was a prospective, longitudinal, observational study of adults with episodic migraine and healthy non-migraine controls. Participants provided speech samples three times per day using a speech elicitation tool included within a mobile app. Six complementary speech features that capture articulation and prosody were extracted from speech samples. Participants with migraine maintained a daily headache diary using the same app. A mixed effects model and t-tests were used to investigate differences in speech features between controls, the migraine pre-attack phase, the migraine attack, and the interictal period.Results: In total, 56,767 speech samples were collected, including 43,102 from 15 individuals with migraine and 13,665 from matched healthy controls. Significant group-level differences in speech features were identified between those with migraine and healthy controls and within the migraine group during the pre-attack vs. attack vs. interictal periods (all p < .05). Most consistently, speech changes occurred in the speaking rate, articulation rate and precision, and phonatory duration. Within-subject analysis revealed that seven of 15 individuals with migraine showed significant change in at least one speech feature when comparing the migraine attack vs. interictal phase and four showed similar changes when comparing the pre-attack vs. interictal phases.Conclusions: Changes in speech occurred in almost half of the individuals during migraine attacks. Once confirmed in subsequent studies, speech changes could be considered a feature of the migraine attack. [ABSTRACT FROM AUTHOR]

Available evidences suggest that a number of known assumption on idiopathic intracranial hypertension (IIH) with or without papilledema might be discussed. These include (1) the primary pathogenetic role of an excessive dural sinus collapsibility in IIH, allowing a new relatively stable intracranial fluids pressure balance at higher values; (2) the non-mandatory role of papilledema for a definite diagnosis; (3) the possibly much higher prevalence of IIH without papilledema than currently considered; (4) the crucial role of the cerebral compliance exhaustion that precede the raise in intracranial pressure and that may already be pathologic in cases showing a moderately elevated opening pressure; (5) the role as "intracranial pressure sensor" played by the trigeminovascular innervation of dural sinuses and cortical bridge veins, which could represent a major source of CGRP and may explain the high comorbidity and the emerging causative link between IIHWOP and chronic migraine (CM). Accordingly, the control of intracranial pressure is to be considered a promising new therapeutic target in CM. [ABSTRACT FROM AUTHOR]

Objective: To understand treatment preferences of people with migraine and the relative importance of improvements in efficacy and avoiding adverse events (AEs), such as cognition problems or weight gain. Background: Current preventive migraine medicines are associated with poor adherence and tolerability. There is an unmet need for effective migraine‐specific preventive treatments with fewer AEs. Methods: In a web‐based discrete‐choice experiment survey, respondents who self‐reported having ≥6 migraine days/month were offered choices between pairs of hypothetical preventive migraine medicines. Six attributes, each with 3 levels, defined the medicines: reduction in headache days per month (10%, 25%, or 50%), frequency of limitations with physical activities (none, 1‐category improvement, or 2‐category improvement), cognition problems (no problems, thinking problems, or memory problems), weight gain (none, 5% body weight gain, or 10% body weight gain), how the medicine is taken (daily oral pill, once‐monthly injection, or twice‐monthly injection), and monthly out‐of‐pocket cost ($5, $60, or $175). The attributes and levels were informed by clinician input, the clinical literature, and 2 focus groups. An experimental design was used to create the pairs of hypothetical medicines for the discrete‐choice experiment questions. Random‐parameters logit was used to estimate the relative importance of the medicine attributes, and the results were used to predict the percentage of respondents who would select one medicine profile over another and to calculate willingness to pay for changes in attribute levels. Results: The sample included 300 respondents; 72% indicated that migraines make physical activities difficult all or most of the time, and 81% had taken a prescription medicine to prevent migraine in the last 6 months. Respondents reported having, on average, approximately 16 headache days per month. Among noncost attributes, respondents valued a change from a 10% reduction in migraine days to a 50% reduction more highly than avoiding the worst levels of AEs, but were willing to trade off efficacy for less‐severe AEs. Avoiding memory problems was more important than avoiding thinking problems. Avoiding a 10% weight gain was more important than avoiding thinking and memory problems. Respondents preferred a once‐monthly injection or daily pill to twice‐monthly injection. Respondents, on average, were willing to pay $84 (95% confidence interval [CI], $64‐$103) per month to avoid a 10% weight gain, $59 (95% CI, $42‐$76) per month to avoid memory problems, $35 (95% CI, $20‐$51) per month to avoid a 5% weight gain, and $32 (95% CI, $18‐$46) per month to avoid thinking problems. Conclusions: A preventive migraine medicine with improved efficacy and AE profile and a favorable mode of administration would be valuable to migraine sufferers. Patients may be willing to trade off efficacy for better AE profiles. Clinicians should work with patients to select treatments that meet each patient's needs. [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]

Objective: This study aimed to assess mechanical hyperalgesia in the trigeminal and extra-trigeminal regions in patients with chronic migraine (CM) and temporomandibular disorders (TMD) in comparison to asymptomatic subjects and to determine the association between sensorimotor variables and psychological and disability variables and evaluate the prediction of a sensorimotor variables though psychological and disability variables in patients with CM and TMD.Material and Methods: A total of 52 subjects with concomitant CM and TMD and 30 asymptomatic subjects were included in the study. The pressure pain threshold (PPT), maximal mouth opening (MMO) and a series of self-reported factors were compared.Results: There were 52 CM and TMD (92.3% women and 7.7% men; age = 46.2 ± 9.5) and 30 asymptomatic subjects (80% women and 20% men; age = 47.4 ± 10). Differences were found between patients with CM and TMD and asymptomatic participants (p < .01) when comparing the PPTs in the trigeminal and extra-trigeminal regions. The PPT for the trigeminal region was predicted by depressive symptoms (variance of 18%) as well as disability and craniofacial pain (variance of 20%). The extra-trigeminal region PPT was predicted by depressive symptoms (variance of 10%), and pain-free MMO was predicted by disability and craniofacial pain (variance of 24%).Conclusions: This study suggests that patients with CM and TMD present with generalized mechanical hyperalgesia. In addition, an association between sensorimotor, psychological and disability variables was observed. [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]

Migraine-type photophobia, most commonly described as exacerbation of headache by light, affects nearly 90% of the patients. It is the most bothersome symptom accompanying an attack. Using subjective psychophysical assessments, we showed that migraine patients are more sensitive to all colors of light during ictal than during interictal phase and that control subjects do not experience pain when exposed to different colors of light. Based on these findings, we suggested that color preference is unique to migraineurs (as it was not found in control subjects) rather than migraine phase (as it was found in both phases). To identify the origin of this photophobia in migraineurs, we compared the electrical waveforms that were generated in the retina and visual cortex of 46 interictal migraineurs to those generated in 42 healthy controls using color-based electroretinography and visual-evoked potential paradigms. Unexpectedly, it was the amplitude of the retinal rod-driven b wave, which was consistently larger (by 14%-19% in the light-adapted and 18%-34% in the dark-adapted flash ERG) in the migraineurs than in the controls, rather than the retinal cone-driven a wave or the visual-evoked potentials that differs most strikingly between the 2 groups. Mechanistically, these findings suggest that the inherent hypersensitivity to light among migraine patients may originate in the retinal rods rather than retinal cones or the visual cortex. Clinically, the findings may explain why migraineurs complain that the light is too bright even when it is dim to the extent that nonmigraineurs feel as if they are in a cave. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated to identify the clinical significance of allodynia compared with other sensory hypersensitivities (SH) in migraine patients.Methods: New patients with migraine were recruited from a headache clinic, and we collected data regarding their clinical characteristics and identified SH including photophobia, phonophobia, osmophobia, and allodynia. The patients completed the 12-item Allodynia Symptom Checklist, Migraine Disability Assessment Scale (MIDAS), Headache Impact Test-6 (HIT-6), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Insomnia Severity Index (ISI), Fatigue Severity Scale (FSS), and Migraine-Specific Quality of Life Questionnaire Version 2.1. We divided the patients into three groups: SH with allodynia (group 1), SH without allodynia (group 2), and no SH (group 3). Clinical characteristics, psychosomatic features, and quality of life (QOL) were compared among these groups.Results: A total of 312 migraine patients participated in the study. Among them, 58 (18.6%), 202 (64.7%), and 52 (16.7%) were allocated to groups 1, 2, and 3, respectively. Chronic migraine, family history of migraine, medication overuse headache, earlier age at onset, longer disease duration, higher headache intensity, and aggravation with physical activity were more prevalent in group 1 than in groups 2 or 3. Scores of the MIDAS, HIT-6, PHQ-9, GAD-7, ISI, and FSS were the highest in group 1, followed by groups 2 and group 3. The lowest QOL was noted in group 1, followed by groups 2 and group 3.Conclusions: This study revealed that SH in migraine, particularly combined with allodynia, may result in poor clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: The current study aimed to describe the impact of parental migraine on adolescent children (aged 11–17) living at home with a parent with migraine. Background: Emerging evidence suggests that migraine impacts the family members of people with migraine. However, there has been little research to evaluate the perspective of the child of a parent with migraine. Methods: This cross‐sectional observational study included parents who met International Classification of Headache Disorders criteria for migraine and their 11–17‐year‐old children currently living with the parent with migraine recruited from neurologist offices and online. Parents completed measures of demographics, a diagnostic migraine criteria screener, parental illness impact (Parental Illness Impact Survey – Revised; subscales = Burden of Daily Help, Emotional Impact, Social Impact, Communication and Understanding, Impact on Personal Future, Friends Reactions, Parent/Child Relationship, and Global Well‐Being), migraine‐related disability (MIDAS), headache attack frequency, and headache attack pain intensity. Children completed measures of demographics, parental illness impact, and a migraine diagnostic screener if applicable. Results: Children (n = 40) reported the greatest impact of their parent's migraine on the Global Well‐Being (M = 3.3, SD = 0.9) and Parent/Child Relationship (M = 3.5, SD = 0.6) subscales. There were no significant differences between the average child and parent rating of parental migraine impact on children. Correlations between parent and child ratings of parental migraine impact were strongest for the Social Impact subscale (ρ = 0.55, P <.001), and non‐significant for the Parent/Child Relationship (ρ = 0.13, P =.416) and Friends Reactions (ρ = 0.18, P =.257) subscales. Higher attack frequency and endorsing severe disability on the MIDAS were associated with higher child‐rated impact (eg, lower scores) on Global Well‐Being (frequency ρ = −0.35, P =.028; MIDAS t(38) = 2.74, P =.009) and Impact on Personal Future (frequency ρ = −0.41, P =.009; MIDAS t(35.7) = 2.49, P =.017) subscales. Higher attack pain intensity was associated with higher child‐rated impact (eg, lower scores) on Burden of Daily Help (r = −0.34, P =.031) and Emotional Impact (r = −0.40, P =.010). Over half of children (23/40, 57.5%) reported some kind of service or intervention to help them manage the impact of their parent's migraine on their lives would be helpful. Conclusions: Parental migraine impacts children aged 11–17 living in the home, particularly in the domains of global well‐being and the parent/child relationship. Parent and child reports are not strongly correlated across all domains of parental impact. [ABSTRACT FROM AUTHOR]

The article discusses the case of a patient diagnosed with Powasan virus encephalitis. Topics discussed include the patient's clinical presentation of fever, headache and progressive encephalopathy, differential diagnosis which include bacterial, fungal and arthropod-borne virus infections, and the results of laboratory tests, computed tomography and magnetic resonance imaging (MRI) of the head. Also discussed are the characteristics of Powassan flavivirus and the treatment of the patient.

Background: Allodynia is prevalent in adults with migraine and has been associated with long disease duration and severe course. Studies of the pediatric population are sparse. The aim of this study was to evaluate the rate of cephalic cutaneous allodynia in children and adolescents within the first 6 months of migraine onset and to identify associated clinical and migraine-related parameters.Methods: The electronic database of a tertiary pediatric headache clinic from 2014 to 2017 was retrospectively searched for all children and adolescents diagnosed with migraine headache within 6 months or less of symptom onset. Cephalic cutaneous allodynia was identified by validated questionnaire. Demographics, symptoms, and headache-related parameters were compared between patients with and without allodynia.Results: The cohort included 119 patients, 69 girls (58.0%) and 50 (42.0%) boys, of mean age 11.6 ± 3.6 years. Mean time since onset of migraine disease was 3.6 ± 1.8 months. Cephalic cutaneous allodynia was reported by 31.1% of patients. It was significantly associated with female gender ( p = 0.03), older age at admission ( p = 0.037), older age at onset ( p = 0.042) migraine with aura ( p = 0.002), and higher rate of awakening pain ( p = 0.017).Conclusions: Cephalic cutaneous allodynia may occur in children and adolescents already in the first 6 months of migraine onset. Contrary to adult studies, we found no association of allodynia with migraine frequency or long disease duration. Allodynia was significantly associated with migraine with aura, female gender, and awakening pain. A genetic tendency may contribute to the appearance of allodynia in the pediatric age group. [ABSTRACT FROM AUTHOR]

Objective: To assess the presence and handicap due to vestibular symptoms in three subgroups of patients with migraine and controls.Methods: Women between 18-55 years old were diagnosed by headache specialists and stratified as migraine with aura (n = 60), migraine without aura (n = 60), chronic migraine (n = 60) and controls (n = 60). Information regarding demographics, headache and vestibular symptoms were collected in this cross-sectional study. The self-perceived handicap related to vestibular symptoms was assessed through the Dizziness Handicap Inventory questionnaire.Results: A total of 85% of women with migraine with aura and chronic migraine had vestibular symptoms contrasted to 70% of the migraine without aura group ( p < 0.05), and 12% of the control group reported symptoms ( p < 0.0001). Patients with migraine exhibited greater Dizziness Handicap Inventory scores than controls ( p < 0.001); and migraine with aura and chronic migraine groups reached greater scores than migraine without aura ( p < 0.01). Presence of migraine is associated with a greater risk of vestibular symptoms (migraine without aura: 5.20, migraine with aura: 6.60, chronic migraine:6.20, p < 0.0003) and with a greater risk of moderate-to-severe handicap (migraine without aura: 20.0, migraine with aura: 40.0, chronic migraine: 40.0, p < 0.0003). The presence of aura and greater migraine frequency adds to the risk of any handicap (migraine with aura: 1.9, chronic migraine: 1.7, p < 0.04) and to the risk of moderate-to-severe handicap (migraine with aura: 2.0, chronic migraine: 2.0, p < 0.0003). Migraine aura, intensity and frequency predict 36% of the dizziness handicap.Conclusion: The prevalence of vestibular symptoms is increased in migraine during and between headache attacks, particularly in migraine with aura and chronic migraine along with an increased handicap due to those symptoms. Vestibular symptoms among subgroups of migraine should be considered when evaluating the functional impact of migraine. [ABSTRACT FROM AUTHOR]

Background: There are cases in the headache literature described as "cluster-migraine," but none of stereotyped cases of cluster headache evolving into status migrainosus. We believe this is the first documented case of "cluster-status migrainosus".Case: A 54 year-old female hospital administrator presented with headaches with a unique periodicity and semiology that were acutely responsive to high-flow oxygen. She experienced cluster headache attacks every Thursday morning at 3-4 am, which would evolve into status migrainosus lasting through Sunday evening. These attacks were preceded by prodromal depressed mood changes and fluid retention, and later followed by postdromal euphoria and auto-diuresis. These attacks initially occurred every other week and progressed to weekly attacks for 1.5 years. These headaches did not respond to trials of propanolol, sodium valproate, topiramate, amitriptyline, gabapentin, and carbamazepine for preventive treatment or to oral sumatriptan and butalbital-acetaminophen-caffeine for acute treatment. We started her on high-flow 100% oxygen for cluster headache, which successfully aborted greater than 80% of her weekly cluster headache attacks and prevented them from evolving into status migrainosus.Conclusion: We believe this is the first case of "cluster-status migranosus" described in the medical literature. High-flow oxygen both aborted the cluster headaches and prevented the ensuing status migrainosus. [ABSTRACT FROM AUTHOR]

Introduction: Osmophobia has been suggested as an additional symptom of migraine without aura, and a high prevalence of osmophobia of up to 50% has been reported in the literature. We conducted a nosographic study of osmophobia in all migraineurs and tension-type headache patients and a field testing of suggested diagnostic criteria of osmophobia, presented in the appendix of the second edition of The International Classification of Headache Disorders and suggested by Silva-Néto et al. and Wang et al ., in migraine without aura and tension-type headache patients (n = 1934).Materials and Methods: Each patient received a validated semi-structured interview. All subjects fulfilled the diagnostic criteria of the second edition of The International Classification of Headache Disorders for migraine or tension-type headache. Statistical analyses were performed using statistical software R. The statistical R package "Caret" was used to construct a confusion matrix and retrieve sensitivity, which is defined as the suggested criteria's ability to correctly diagnose migraine without aura patients, and specificity, defined as the suggested criteria's ability to not wrongly diagnose tension-type headache patients.Results: Osmophobia was present in 33.5% of patients with migraine with aura, in 36.0% of patients with migraine without aura, and in 1.2% of patients with tension-type headache. All migraineurs with osmophobia also fulfilled the current criteria for migraine by having nausea or photophobia and phonophobia. The appendix criteria had a sensitivity of 0.96 and a specificity of 0.99 for migraine without aura, and a sensitivity of 0.65 and a specificity of 0.99 for probable migraine without aura. Both the criteria by Silva-Néto et al. and Wang et al. had a sensitivity of 0.98 and a specificity of 0.99 for migraine without aura, and a sensitivity of 0.66 and a specificity of 0.99 for probable migraine without aura.Discussion: This study demonstrates the remarkable specificity of osmophobia. The criteria by Silva-Néto et al. and Wang et al. both had a higher sensitivity than the appendix criteria for migraine without aura; all three criteria had a low sensitivity for probable migraine without aura. However, neither the appendix criteria nor the criteria by Silva-Néto et al. or Wang et al. added any extra patients that would not have been diagnosed by the current diagnostic criteria for migraine. Osmophobia is a valuable symptom that may be useful to differentiate between migraine without aura and tension-type headache in difficult clinical cases.Conclusion: Our results do not suggest that alterations of the current diagnostic criteria for migraine without aura are needed. [ABSTRACT FROM AUTHOR]

Objectives: We examined the cross‐sectional association of sleep apnea and indices of sleep quality with both episodic migraine (EM) and chronic migraine (CM). Background: Sleep apnea and abnormal patterns of sleep, such as insomnia, were associated with migraine onset, severity, and progression in previous research. Methods: The Chronic Migraine Epidemiology & Outcomes Study, a longitudinal study, used a series of web‐based surveys to assess migraine symptoms, burden, and patterns of health care utilization. Quota sampling was used from September 2012 to November 2013 to generate a representative sample of the US population. Persons who screened positive for sleep apnea on the Berlin Questionnaire are said to be at "high risk" for sleep apnea. Respondents indicated if they believed that they had sleep apnea, if a physician had diagnosed it, and if and how they were treated. Other aspects of sleep quality were assessed using the Medical Outcomes Study (MOS) Sleep Measures. Results: Of 12,810 eligible respondents with migraine and data on sleep, 11,699 with EM (91.3%) and 1111 with CM (8.7%) provided valid data for this analyses. According to the Berlin Questionnaire, 4739/12,810 (37.0%) were at "high risk" for sleep apnea, particularly persons with CM vs EM (575/1111 [51.8%] vs 4164/11,699 [35.6%]), men vs women (1431/3220 [44.4%] vs 3308/9590 [34.5%]), people with higher body mass index, and older people (all P < .001). Among respondents to the MOS Sleep Measures, persons with CM were more likely to report poor sleep quality than those with EM, including sleep disturbance (mean [SD] values: 53.2 [26.9] vs 37.9 [24.3]), snoring (38.0 [33.9] vs 31.0 [32.1]), shortness of breath (34.9 [29.8] vs 15.3 [20.6]), somnolence (44.1 [23.4] vs 32.2 [21.2]), and less likely to report sleep adequacy (34.0 [24.2] vs 39.2 [22.1]). Conclusions: Compared with respondents with EM, a larger proportion of those with CM were at "high risk" for sleep apnea and reported poor sleep quality. This reflects an association between CM vs EM and sleep apnea and poor sleep quality; the potential relationships are discussed. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the association between migraine and the markers of carotid artery disease. Background: Migraine increases the risk of cardiovascular events, but its relationship with vascular dysfunction is unclear. Methods: In this cross‐sectional study, middle‐aged women with no known cardiovascular diseases underwent clinical, neurological, and laboratory evaluations; pulse wave velocity (PWV) assessment; and carotid artery ultrasonography. We divided the participants based on the presence of migraine and, further, based on the type of migraine. Associations between migraine and carotid thickening (intima‐media thickness >0.9 mm), carotid plaques, or arterial stiffening (PWV >10 m/s) were evaluated using a multiple regression analysis. Results: The study comprised 112/277 (40%) women with migraine, of whom 46/277 (17%) reported having an aura. Compared to the non‐migraineurs, the migraine with aura group had an increased risk of diffuse carotid thickening (3/46 [6.8%] vs 2/165 [1.3%], adjusted OR = 7.12, 95% CI 1.05–48.49). Migraine without aura was associated with a low risk of carotid plaques (3/66 [4.7%] vs 26/165 [16.7%], adjusted OR = 0.28, 95% CI 0.08–0.99) and arterial stiffening (21/66 [34.4%] vs 82/165 [51.2%], adjusted OR = 0.39, 95% CI 0.19–0.79). There were no correlations between migraine characteristics and arterial stiffness or carotid thickness measurements. Conclusion: Migraine with aura is associated with an increased risk of carotid thickening, and migraine without aura is associated with a low risk of carotid plaques and arterial stiffening. [ABSTRACT FROM AUTHOR]

Objective: Previous case–control studies have suggested that women with migraine have lower risk of developing breast cancer, but conflicting results were noted in cohort studies. We investigated the association between migraine and breast cancer incidence in a nationwide population-based cohort study. Methods: We identified 25,606 women with migraine between 2000 and 2013 from the National Health Insurance Research Database in Taiwan. Each migraineur was randomly frequency matched with four women without migraine by age and index year of migraine diagnosis. Cox's proportional hazard regression analysis was performed to estimate the association between migraine on the risk of developing breast cancer. Results: With a mean follow-up of 7.3 years, 234 and 978 breast malignancies occurred in the migraine cohort and matched cohort, respectively. Migraine was not associated with the risk of breast cancer (adjusted hazard ratio = 1.03, 95% confidence interval = 0.89–1.21). Among women with migraine, independent risk factors for breast cancer included older age, alcohol-related illness, and receipt of a greater number of breast cancer screening examinations, and independent protective factors included the use of antihypertensive agents, statins, and nonsteroidal anti-inflammatory drugs. Further analyses indicated that women with ≥4 medical visits for migraine per year had a significantly greater risk of breast cancer than the matched cohort. Conclusions: Migraine was not associated with a decreased risk of developing breast cancer among Taiwanese women. Further prospective studies on other geographic populations or on the association between migraine frequency and the risk of developing breast cancer are warranted to validate our findings. [ABSTRACT FROM AUTHOR]

Background: Alien Hand Syndrome (AHS) is an uncontrollable, involuntary, but in appearance, purposeful motor control disorder of the upper extremity.Case Report: A 42-year-old male patient was admitted to our clinic complaining of involuntary motor activity in his right hand. He had a previous history of migraine with visual aura. The uncontrollable motor control disorder was compatible with Alien Hand Syndrome, which was appearing immediately after the visual aura and before the beginning of headache.Conclusion: Alien Hand Syndrome is usually observed with anterior cerebral artery infarction, midline tumors, trauma and several neurodegenerative diseases, but is rarely seen in paroxysmal conditions such as migraine with aura. [ABSTRACT FROM AUTHOR]

Background Few studies have examined whether migraine is associated with an increased risk of incident hypertension. Methods We performed a prospective cohort study among 29,040 women without hypertension at baseline. Women were classified as having active migraine with aura, active migraine without aura, a past history of migraine, or no history of migraine. Incident hypertension was defined as new physician diagnosis or newly self-reported systolic or diastolic blood pressure ≥140 mmHg or ≥90 mmHg respectively. Cox proportional hazards models were used to evaluate the association between migraine and incident hypertension. Results During a mean follow-up of 12.2 years, 15,176 incident hypertension cases occurred. Compared to those with no history of migraine, women who experience migraine with aura had a 9% increase in their risk of developing hypertension (95% CI: 1.02, 1.18); women who experience migraine without aura had a 21% increase in their risk of developing hypertension (95% CI: 1.14, 1.28); and women with a past history of migraine had a 15% increase in their risk of developing hypertension (95% CI: 1.07, 1.23). Conclusions Women with migraine have a higher relative risk of developing hypertension compared to women without migraine. [ABSTRACT FROM AUTHOR]

Aversion to light is common among migraineurs undergoing acute attacks. Using psychophysical assessments in patients with episodic migraine, we reported that white, blue, amber, and red lights exacerbate migraine headache in a significantly larger percentage of patients and to a greater extent compared with green light. This study aimed at determining whether these findings are phase-dependent-namely, manifested exclusively during migraine (ictally) but not in its absence (interictally), or condition-dependent-ie, expressed uniquely in migraineurs but not in healthy controls. To determine whether the color preference of migraine-type photophobia is phase- or condition-dependent, we compared the effects of each color of light in each intensity between migraineurs during and in-between attacks and healthy controls. During the ictal and interictal phases, the proportion of migraineurs reporting changes in headache severity when exposed to the different colors of light increased in accordance with elevated light intensities. During the ictal phase, white, blue, amber, and red lights exacerbated headaches in ∼80% of the patients; however, during the interictal phase, light initiated headache in only 16% to 19%. Notably, green light exacerbated headaches in 40% and triggered headaches in 3% of the patients studied during the ictal and interictal phases, respectively. With one exception (highest red light intensity), no control subject reported headache in response to the light stimuli. These findings suggest that color preference is unique to migraineurs-as it was not found in control subjects-and that it is independent of whether or not the patients are in their ictal or interictal phase. [ABSTRACT FROM AUTHOR]

Copyright of Agri: Journal of the Turkish Society of Algology / Tu?rk Algoloji (Ag?r?) Derneg?i'nin Yayin Organidir is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Migraine and cerebrovascular diseases are disabling disorders, which are possibly closely interrelated. Heterogeneous and scattered evidence in literature remains a challenge. We searched for systematic reviews including diverse cerebrovascular events in migraineurs and reported relevant original studies to update the evidence when necessary. The studies show that migraine is associated with increased risk of transient ischemic attacks, any stroke, and possibly hemorrhagic stroke. In addition, migraine with aura increases the risk of ischemic stroke and white matter abnormalities. Migraine without aura increases the risk of cervical artery dissection as a cause of ischemic stroke. Groups with specific risk profiles are women, young people, smokers, and oral contraceptive users. The pathophysiology of the association remains uncertain. However, genetic and environmental factors may be involved in intricate mechanisms responsible for oxidative stress, vascular dysfunction and, ultimately, vascular events. In conclusion, migraine is a potential risk factor for cerebrovascular diseases. Migraineurs should be carefully evaluated considering their vascular risk assessment based on current evidence, so that healthcare professionals can provide appropriate and individualized management of other cardiovascular risk factors, notably quitting smoking and restricting use of oral contraceptives. [ABSTRACT FROM AUTHOR]

Background: Visually induced analgesia (VIA) defines a phenomenon in which viewing one's own body part during its painful stimulation decreases the perception of pain. VIA occurs during direct vision of the stimulated body part and also when seeing it reflected in a mirror. To the best of our knowledge, VIA has not been studied in the trigeminal area, where it could be relevant for the control of headache. Subjects and methods: We used heat stimuli (53°C) to induce pain in the right forehead or wrist in 11 healthy subjects (HSs) and 14 female migraine without aura (MO) patients between attacks. The subjects rated pain on a visual analog scale (VAS) and underwent contact heat-evoked potential (CHEP) recordings (five sequential blocks of four responses) with or without observation of their face/wrist in a mirror. Results: During wrist stimulation, amplitude of the first block of P1–P2 components of CHEPs decreased compared to that in the control recording when HSs were seeing their wrist reflected in the mirror (p = 0.036; Z = 2.08); however, this was not found in MO patients. In the latter, the VAS pain score increased viewing the reflected wrist (p = 0.049; Z = 1.96). Seeing their forehead reflected in the mirror induced a significant increase in N2 latency of CHEPs in HSs, as well as an amplitude reduction in the first block of P1–P2 components of CHEPs both in HSs (p = 0.007; Z = 2.69) and MO patients (p = 0.035; Z = 2.10). Visualizing the body part did not modify habituation of CHEP amplitudes over the five blocks of averaged responses, neither during wrist nor during forehead stimulation. Conclusion: This study adds to the available knowledge on VIA and demonstrates this phenomenon for painful stimuli in the trigeminal area, as long as CHEPs are used as indices of central pain processing. In migraine patients during interictal periods, VIA assessed with CHEPs is within normal limits in the face but absent at the wrist, possibly reflecting dysfunctioning of extracephalic pain control. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to investigate restless legs syndrome, depression, frequency of fibromyalgia and possible causes of its frequencies, and the relationships among these synergies and migraine's prodrome, aura, pain, and postdrome symptoms in patients with migraine.Subjects and Methods: The study group included 200 patients previously or recently diagnosed with definite migraine and according to International Headache Society criteria and 200 healthy volunteers. All subjects underwent a medical interview to confirm restless legs syndrome and fibromyalgia, and they were asked to complete Beck Depression and Anxiety Inventory and "severity of restless legs syndrome inventory."Results: The frequencies of depressive symptoms and fibromyalgia in the patients with migraine were higher than those of the control group. The mean age of the migraine patients with restless legs syndrome was also higher, and this group had migraine headache for a longer time. There was a statistically significant difference with regard to only generalized anxiety and traveler's distress, which were features of the migraine, between migraine patients with and without restless legs syndrome. Restless legs syndrome was more common in migraine patients with and without aura and in those with nonspecific white matter lesions in the cranial MRI.Conclusions: In our study, the greater frequency of restless legs syndrome, depressive symptoms, and fibromyalgia in the patients with migraine supports the role of dopamine, which is common to all three disorders. Interviews focused on these problems among migraine patients may help to decide on the best available treatment modality. [ABSTRACT FROM AUTHOR]

Phytotherapy is a source of finding new remedies for migraine. Traditional chamomile oil (chamomile extraction in sesame oil) is a formulation in Persian medicine (PM) for pain relief in migraine. An oleogel preparation of reformulated traditional chamomile oil was prepared and then standardized based on chamazulene (as a marker in essential oil) and apigenin via gas chromatography (GC) and high-performance liquid chromatography (HPLC) methods, respectively. A crossover double-blind clinical trial was performed with 100 patients. Each patient took two tubes of drug and two tubes of placebo during the study. Visual analog scale (VAS) questionnaires were filled in by the patients and scores were given, ranging from 0 to 10 (based on the severity of pain) during 24 h. Other complications like nausea, vomiting, photophobia, and phonophobia were also monitored. There was 4.48 ± 0.01 μl/ml of chamazulene and 0.233 mg/g of apigenin in the preparation (by correcting the amount with extraction ratio). Thirty-eight patients in the drug-placebo and 34 patients in the placebo-drug groups (a total number of 72 patients as per protocol) completed the process in the randomized controlled trial (RCT). Adapted results from the questionnaires showed that pain, nausea, vomiting, photophobia, and phonophobia significantly (p < 0.001) decreased by using chamomile oleogel on the patients after 30 min. Results supported the efficacy of chamomile oleogel as a pain relief in migraine without aura. [ABSTRACT FROM AUTHOR]