Migraine polygenic risk score associates with efficacy of migraine-specific drugs. Kogelman Lisette J A,Esserlind Ann-Louise,Francke Christensen Anne,Awasthi Swapnil,Ripke Stephan,Ingason Andres,Davidsson Olafur B,Erikstrup Christian,Hjalgrim Henrik,Ullum Henrik,Olesen Jes,Folkmann Hansen Thomas, Neurology. Genetics Objective:To assess whether the polygenic risk score (PRS) for migraine is associated with acute and/or prophylactic migraine treatment response. Methods:We interviewed 2,219 unrelated patients at the Danish Headache Center using a semistructured interview to diagnose migraine and assess acute and prophylactic drug response. All patients were genotyped. A PRS was calculated with the linkage disequilibrium pred algorithm using summary statistics from the most recent migraine genome-wide association study comprising ∼375,000 cases and controls. The PRS was scaled to a unit corresponding to a twofold increase in migraine risk, using 929 unrelated Danish controls as reference. The association of the PRS with treatment response was assessed by logistic regression, and the predictive power of the model by area under the curve using a case-control design with treatment response as outcome. Results:A twofold increase in migraine risk associates with positive response to migraine-specific acute treatment (odds ratio [OR] = 1.25 [95% confidence interval (CI) = 1.05-1.49]). The association between migraine risk and migraine-specific acute treatment was replicated in an independent cohort consisting of 5,616 triptan users with prescription history (OR = 3.20 [95% CI = 1.26-8.14]). No association was found for acute treatment with non-migraine-specific weak analgesics and prophylactic treatment response. Conclusions:The migraine PRS can significantly identify subgroups of patients with a higher-than-average likelihood of a positive response to triptans, which provides a first step toward genetics-based precision medicine in migraine. 10.1212/NXG.0000000000000364
    The premonitory phase of migraine and migraine management. Becker Werner J Cephalalgia : an international journal of headache OBJECTIVE:The objective was to determine, through a literature review, whether treatment during the premonitory phase of migraine is a potentially useful migraine management strategy. METHODS:A general literature review was done with regard to the nature of migraine premonitory symptoms, their frequency, their reliability in predicting migraine attacks, and the effectiveness of medication treatment when given during the premonitory phase. RESULTS:Many different symptoms have been reported as premonitory symptoms that occur before migraine attacks. Up to 87% of patients with migraine may experience premonitory symptoms, although some studies have provided estimates as low as 33%. In selected patients, premonitory symptoms may be relatively reliable predictors of a migraine attack to follow. Both naratriptan (open-label study) and domperidone (double-blind, randomized, placebo-controlled study) have been reported to be effective when given during the premonitory phase. CONCLUSIONS:More research is needed, but there is some evidence that medication treatment during the premonitory phase has the potential to be helpful in selected patients with migraine. 10.1177/0333102412437390
    Ciliary ganglioplegic migraine: migraine-related prolonged mydriasis. Barriga F J,López de Silanes C,Gili P,Pareja J A Cephalalgia : an international journal of headache BACKGROUND:Transient, unilateral mydriasis has been reported in migraine patients, and this has been regarded as a possible co-morbidity between migraine and Adie's tonic pupil. Mydriasis that outlasts the duration of migraine attacks is rare. METHODS:Through an eight-year period we have studied all patients referred to our neurological clinic because of migraine attack with mydriasis. All the patients underwent thorough neurologic and ophthalmologic examinations including MRI of the brain and testing of the pupil response to ocular instillation of dilute pilocarpine (0.125%). RESULTS:Seven women and two men, with a mean age of 33.8 ± 12.3 years (range: 19-52) were included. The patients presented during one hemicranial migraine attack with an ipsilateral mydriasis that persisted for a mean of three months, while migraine headaches remained with their typical episodic course. In all the patients a cholinergic supersensitivity in the symptomatic pupil was demonstrated, thus pointing to a dysfunction of the ipsilateral ganglionic parasympathetic fibers. CONCLUSIONS:Synchronous co-localization of the features suggests a pathogenic link between the pupil dysfunction and migraine, rather than a simultaneous coexistence of two independent disorders. Likely explanations include a latent Adie's pupil that could have been triggered during a particular migraine attack; a ciliar ganglionic lesion/dysfunction produced by the migrainous process; an ophthalmoplegic migraine with selective parasympathycoparesis; or an episodic ciliar ganglionitis with migrainous features. Ciliary ganglioplegic migraine is proposed as a nominal term pointing to the possible anatomic source of the migrainous-related pupil dysfunction; the pathogenesis remains unknown. 10.1177/0333102410381144
    Vestibular migraine. Stolte Benjamin,Holle Dagny,Naegel Steffen,Diener Hans-Christoph,Obermann Mark Cephalalgia : an international journal of headache BACKGROUND:The combination of vertigo, dizziness and balance disturbance with migraine is called vestibular migraine. Although it is estimated that up to 1% of the population suffers from this disease, it is still widely unknown and often underdiagnosed. Recently, the International Headache Society and the Báràny Society published the first joint document with mutually accepted diagnostic criteria for vestibular migraine. METHOD:This review summarizes current knowledge on vestibular migraine with regard to epidemiology, clinical presentation, pathophysiology, differential diagnosis and therapeutic options. RESULTS:Approximately 30-50% of patients with migraine report vertigo, dizziness or balance disturbances with at least one migraine attack. Vestibular migraine often appears in a temporal delay to the first onset of migraine headache. In some patients the symptom of sudden onset disequilibrium was the main complaint and more worrisome than the accompanying migraine headache. The duration of attacks varies from a few seconds up to few days. The underlying pathophysiology of vestibular migraine is still widely unknown. As an important differential diagnosis, Ménière's disease has to be considered and excluded. CONCLUSION:As randomized controlled treatment trials are still missing in vestibular migraine, the therapeutic recommendations for vestibular migraine are currently based on the guidelines of migraine. 10.1177/0333102414535113
    Ophthalmoplegic migraine: migraine or oculomotor neuropathy? Margari Lucia,Legrottaglie Anna R,Craig Francesco,Petruzzelli Maria G,Procoli Ugo,Dicuonzo Franca Cephalalgia : an international journal of headache BACKGROUND:Ophthalmoplegic migraine (OM) is a rare condition characterized by the association of headaches and an oculomotor nerve palsy. The third cranial nerve is commonly involved in recurrent attacks, whereas involvement of the sixth and fourth nerves is uncommon. It is still debated whether an uncontrolled migraine or an oculomotor neuropathy may be the primary cause of ophthalmoplegic migraine. CASES:We report two patients affected by OM with normal magnetic resonance imaging findings and a history of uncontrolled migraine before an attack of OM. CONCLUSION:The cases reported allow us to hypothesize that OM may be considered a form of migraine rather than a cranial neuralgia. It is possible that different factors such as inflammatory or structural factors, may represent a vulnerability of the nerve during a severe migraine attack causing ophthalmoplegia. 10.1177/0333102412463493
    Vestibular Migraine. Lempert Thomas,von Brevern Michael Neurologic clinics The term vestibular migraine designates recurrent vertigo that is caused by migraine. Vestibular migraine presents with episodes of spontaneous or positional vertigo lasting seconds to days that are accompanied by migraine symptoms. Because headache is often absent during acute attacks, other migraine features have to be identified by thorough history taking. In contrast, vestibular testing serves mainly for the exclusion of other diagnoses. Treatment still lacks solid evidence. It is targeted at the underlying migraine and comprises explanation and reassurance, lifestyle modifications, and drugs. 10.1016/j.ncl.2019.06.003
    Migraine. Dodick David W Lancet (London, England) Migraine is a chronic paroxysmal neurological disorder characterised by multiphase attacks of head pain and a myriad of neurological symptoms. The underlying genetic and biological underpinnings and neural networks involved are coming sharply into focus. This progress in the fundamental understanding of migraine has led to novel, mechanism-based and disease-specific therapeutics. In this Seminar, the clinical features and neurobiology of migraine are reviewed, evidence to support available treatment options is provided, and emerging drug, device, and biological therapies are discussed. 10.1016/S0140-6736(18)30478-1
    Migraine Pathophysiology. Qubty William,Patniyot Irene Pediatric neurology Migraine is the leading cause of years lost due to disability in individuals aged 15 to 49 years. Much has changed over the last three decades about our understanding of this complex neurological disorder. Various phases of migraine have been characterized and are the focus of this review. The premonitory phase involves bothersome symptoms experienced hours to days before migraine pain. Behavioral changes and functional neuroimaging studies point toward hypothalamic involvement during the premonitory and other migraine phases. Migraine aura is a disruptive, reversible neurological phenomenon that affects up to one-third of all migraineurs, and can overlap with the headache phase. The mechanism responsible for this phase is thought to be cortical spreading depolarization through the cortex. This process leads to temporary disruptions in ion homeostasis and the ensuing neuronal dysfunction. The headache phase involves activation of the trigeminocervical complex. Neuropeptides are implicated in trigeminal activation, and calcitonin gene-related peptide in particular has become a promising target of therapeutic intervention for migraine. The final phase of migraine is the postdrome, the period of time from the resolution of headache symptoms until return to baseline following a migraine. People often report neuropsychiatric, sensory, gastrointestinal, and general symptoms during this time, which can limit activity. Elucidating the neuroanatomical, chemical, and neuroimaging correlates of these migraine phases allows for an improved comprehension of the underlying changes associated with migraine symptomatology and can assist with evaluation of arising therapeutics for migraine management. 10.1016/j.pediatrneurol.2019.12.014
    PACAP27 induces migraine-like attacks in migraine patients. Ghanizada Hashmat,Al-Karagholi Mohammad Al-Mahdi,Arngrim Nanna,Olesen Jes,Ashina Messoud Cephalalgia : an international journal of headache INTRODUCTION:Pituitary adenylate cyclase-activating polypeptide (PACAP) is found in two functional isoforms, namely PACAP38 and PACAP27. The migraine-inducing properties of PACAP38 are well studied. However, it is not known whether the lesser-known and under-studied protein isoform, PACAP27, can also induce migraine attacks. Here, we studied the effect of human PACAP27 infusion on induction of migraine in a provocation model. METHODS:In a crossover study, 20 migraine without aura patients were randomly assigned to receive human PACAP27 (10 picomol/kg/min) or saline (placebo) infusion over 20 min. We recorded the migraine and associated symptoms. RESULTS:All patients completed the study. PACAP27 provoked migraine-like attacks in 11 patients (55%) and two developed attacks after placebo (10%) ( = 0.022). The headache intensity and duration after PACAP27 was significantly greater compared to placebo ( = 0.003). CONCLUSION:PACAP27 triggers migraine attacks without aura. These novel data strengthen the role of PACAP and its receptors in migraine pathogenesis. 10.1177/0333102419864507
    The Combined Effects of ω -3 Fatty Acids and Nano-Curcumin Supplementation on Intercellular Adhesion Molecule-1 (ICAM-1) Gene Expression and Serum Levels in Migraine Patients. Soveyd Neda,Abdolahi Mina,Djalali Mahmoud,Hatami Mahsa,Tafakhori Abbas,Sarraf Payam,Honarvar Niyaz Mohammadzadeh CNS & neurological disorders drug targets BACKGROUND:Migraine is an episodic headache, which is an endothelial disorder with neurological inflammation. Intercellular Adhesion Molecule-1 (ICAM-1), as an endothelial factor, leads to the adhesion of leukocytes to the walls of the cerebral blood vessels, which is an important step in the inflammation process. Curcumin and omega-3 fatty acids, by affecting transcription factors, can regulate the gene expression and serum levels of ICAM-1. Thus, this study aimed to evaluate the synergistic effects of ω-3 fatty acids and nano-curcumin on ICAM-1 gene expression and serum levels in migraine patients. METHOD:This clinical trial study was conducted on 72 episodic migraine patients in 4 groups for 2 months, with patients receiving ω-3 fatty acids, nano-curcumin, a combination of them, or a placebo during the study. At the beginning and end of the study, the gene expression and serum level of ICAM-1 were measured by real-time PCR and ELISA. RESULT:The results showed no significant change in ICAM-1 gene expression in any of the 4 groups. The ICAM-1 serum concentration in the combination group, and omega-3 alone, showed a significant reduction at the end of the study compared to the beginning. In addition, a significant reduction in attack frequency was observed in the combination group. CONCLUSION:Considering the results of supplementation with omega-3 fatty acids plus curcumin led to reductions of both attack frequency and ICAM-1 serum level in patients, it seems that supplementation with these two nutrients not only can lead to improvements in the function of metabolic pathways, but can also be used effectively as a treatment or prevention of migraine complications. 10.2174/1871527317666171213154749