ABSTRACT
Cranial nerve blocks (CNBs) have been used for the acute and preventive treatment of a variety of headaches, including migraine. The effectiveness of CNBs in migraine is usually observed beyond the duration of the nerve block, possibly due to central pain modulation. The most used target is the greater occipital nerve. Other commonly targeted nerves are the lesser occipital nerve and various branches of the trigeminal nerve, including the supratrochlear, supraorbital, and auriculotemporal nerves. CNBs are generally safe and well-tolerated procedures that can be performed in either emergency or outpatient settings. There is currently no guideline standardizing CNBs in migraine. In clinical practice, as well as the few published studies, the results are encouraging, justifying further studies in the area. In the present study we critically review the literature about the safety and efficacy of CNBs in the treatment of migraine attacks and in the preventive treatment of migraine.
Bloqueios de nervos cranianos (BNCs) têm sido usados ââpara o tratamento agudo e preventivo de uma variedade de dores de cabeça, incluindo enxaqueca. A eficácia dos BNC na enxaqueca é geralmente observada além da duração do bloqueio nervoso, possivelmente devido à modulação central da dor. O alvo mais utilizado é o nervo occipital maior. Outros nervos comumente alvo são o nervo occipital menor e vários ramos do nervo trigêmeo, incluindo os nervos supratroclear, supraorbital e auriculotemporal. Os CNBs são geralmente procedimentos seguros e bem tolerados que podem ser realizados em ambientes de emergência ou ambulatoriais. Atualmente não há nenhuma diretriz padronizando BNCs na enxaqueca. Na prática clínica, assim como nos poucos estudos publicados, os resultados são animadores, justificando novos estudos na área. No presente estudo revisamos criticamente a literatura sobre a segurança e eficácia dos BNC no tratamento de crises de enxaqueca e no tratamento preventivo da enxaqueca.
ABSTRACT
OBJECTIVE: The periaqueductal gray matter (PAG), a small midbrain structure, presents dysfunction in migraine. However, the precise neurological mechanism is still not well understood. Herein, the aim of this study was to investigate the texture characteristics of altered PAG in episodic migraine (EM) patients based on high resolution brain structural magnetic resonance (MR) images. MATERIALS AND METHODS: The brain structural MR images were obtained from 18 normal controls (NC), 18 EM patients and 16 chronic migraine (CM) patients using a 3T MR system. A PAG template was created using the International Consortium Brain Mapping 152 gray matter model, and the individual PAG segment was developed by applying the deformation field from the structural image segment to the PAG template. A grey level co-occurrence matrix was used to calculate the texture parameters including the angular second moment (ASM), contrast, correlation, inverse difference moment (IDM) and entropy. RESULTS: There was a significant difference for ASM, IDM and entropy in the EM group (998.629 ± 0.162 × 10−3, 999.311 ± 0.073 × 10−3, 916.354 ± 0.947 × 10−5) compared to that found in the NC group (998.760 ± 0.110 × 10−3, 999.358 ± 0.037 × 10−3 and 841.198 ± 0.575 × 10−5) (p < 0.05). The entropy was significantly lower among the patients with CM (864.116 ± 0.571 × 10−5) than that found among patients with EM (p < 0.05). The area under the receiver operating characteristic curve was 0.776 and 0.750 for ASM and entropy in the distinction of the EM from NC groups, respectively. ASM was negatively related to disease duration (DD) and the Migraine Disability Assessment Scale (MIDAS) scores in the EM group, and entropy was positively related to DD and MIDAS in the EM group (p < 0.05). CONCLUSION: The present study identified altered MR image texture characteristics of the PAG in EM. The identified texture characteristics could be considered as imaging biomarkers for EM.
Subject(s)
Humans , Biomarkers , Brain , Brain Mapping , Entropy , Gray Matter , Magnetic Resonance Imaging , Mesencephalon , Migraine Disorders , Periaqueductal Gray , ROC CurveABSTRACT
Aims: There is evidence that endothelial nitric oxide synthase has a role in migraine pathophysiology. In our research, the role of SNP rs2070744 (c.-813C>T) in promoter region of NOS3 gene in the episodic and chronic forms of migraine is considered. Place and Duration of Study: University Headache Clinic between June 2012 and November 2014 and Department of Genetics, Faculty of Biology of Lomonosov Moscow State University between October 2013 and March 2016. Methodology: The study included 138 patients with migraine (44 with chronic and 96 with episodic migraine). The control group included 348 unexamined subjects. Genotypes were determined using real-time PCR with allelic discrimination test. Statistical processing was performed using Fisher test and Pearson's chi-squared test. Results: Our study evaluated the link of CC genotype of rs2070744 with migraine (Fisher’s p=0.026) and episodic migraine (Fisher’s p=0.022). Conclusion: Genotype CC of SNP rs2070744 in the regulatory region of NOS3 gene is more specific for episodic migraine and may prevents the chronification of migraine.
ABSTRACT
Resumo Introdução: O ácido láctico é um subproduto do metabolismo muscular e do sistema nervoso central. As alterações no metabolismo estão relacionadas com diversas condições fisiológicas e patológicas. O objetivo deste estudo foi determinar a relação entre a enxaqueca e a fibromialgia com os níveis de ácido láctico no sangue. Métodos: Foram estudados 93 pacientes, divididos em cinco grupos: 1) fibromialgia (n = 20); 2) enxaqueca episódica (n = 20); 3) enxaqueca crônica (n = 20); 4) fibromialgia e enxaqueca episódica (n = 13); e 5) fibromialgia e enxaqueca crônica (n = 20), além de 20 indivíduos saudáveis (grupo controle). Os níveis sanguíneos de ácido láctico foram medidos em quatro momentos : em repouso, durante o exercício aeróbico, durante a atividade física anaeróbica e durante o descanso depois do exercício anaeróbico. Resultados: O ácido láctico aumentou em todos os grupos durante a atividade física anaeróbica, sem predominância em qualquer grupo. Durante a atividade física aeróbica, todos os grupos apresentaram um aumento nos níveis de ácido láctico, mas esse aumento foi mais expressivo nos grupos de enxaqueca crônica e enxaqueca crônica com fibromialgia, sem significância estatística. Conclusões: Não foram encontradas anormalidades que envolvessem o metabolismo do ácido láctico na enxaqueca episódica e crônica, na presença ou não de fibromialgia.
Abstract Background: Lactic acid is a byproduct of both muscle metabolism and the central nervous system. Changes in metabolism are related to various physiological and pathological conditions. The aim of this study was to determine the relationship between migraine and fibromyalgia with the levels of lactic acid in the blood. Methods: We study 93 patients divided into five groups: (1) patients with fibromyalgia (n = 20); (2) episodic migraine (n = 20); (3) chronic migraine (n = 20); (4) fibromyalgia and episodic migraine (n = 13); and (5) fibromyalgia and chronic migraine (n = 20), and 20 healthy subjects (control group). Blood levels of lactic acid were measured at four different time points: at rest, during aerobic exercise, during anaerobic physical activity and while resting after anaerobic exercise. Results: Lactic acid increased in all groups during anaerobic physical activity without predominance for either group. During aerobic physical activity, all groups increased lactic acid levels, but the increase was more expressive in the chronic migraine group and the chronic migraine with fibromyalgia group without statistical significance. Conclusions: We did not found abnormalities involving the metabolism of lactic acid in episodic and chronic migraine with or without fibromyalgia.
Subject(s)
Humans , Fibromyalgia/blood , Lactic Acid/blood , Migraine Disorders/blood , Exercise , Case-Control StudiesABSTRACT
BACKGROUND: In this study, the quality of life of patients with chronic and episodic migraine was compared using quality of life assessments tools, which included the MIDAS (migraine disability assessment) questionnaire and MSQoL (migraine-specific quality of life) questionnaire. METHODS: The investigation occurred from November 2005 to April 2006 for patients who visited the neurology department of hospital in because of headache. The patients for the question investigation consisted of 34 patients with chronic migraine (CM) and 48 patients with episodic migraine (EM). The diagnosis of migraines was obtained by the migraine criteria of the International Headache Society (IHS). RESULTS: In the comparisons of the MIDAS score in patients with CM and EM, the second question (reduced effectiveness at work/school), the fourth question (reduced effectiveness in housework), total scores (28+/-19.7 versus 12.0+/-10.1, p<.01), and the question A were higher in CM patients (51.2+/-20.1 versus 15.5+/-13.1, p<.01). MIDAS grade of CM patients were also higher than EM patients. In MSQoL score comparisons of CM and EM patients, three parts of life qualities, which are role-function restrictive, role-function preventive, and emotional function due to headache, and total score (61.9+/-11.7 versus 73.7+/-13.9, p<.01) was less in CM patients than EM patients. CONCLUSIONS: The study shows that life qualities of the patients with CM were significantly lower than of the patients with EM.