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Article in Chinese | WPRIM | ID: wpr-936260


Objective: To analyze the characteristics of heart rate variability (HRV) in patients with vestibular migraine (VM) and to explore its possible mechanism. Methods: Forty-eight patients with VM [17 males and 31 females, age (36.2±9.2) years], 44 patients with migraine [15 males and 29 females, age (34.4±9.0) years], and 30 patients with health check-ups during the same period [12 males and 18 females, age (34.6±6.5) years old] were selected as study subjects. Ambulatory ECG monitoring was performed in all subjects, and the HRV characteristics of each group were analyzed from both daytime and nighttime time phases. Time domain parameters were analyzed: standard deviation of normal to normal (SDNN), root mean square of successive differences (RMSSD), and percentage of normal to normal intervals differing by more than 50 ms (pNN50). The parameters in the frequency domain were analyzed: high frequency power (HF), low frequency power (LF), and the ratio of low frequency to high frequency power (LF/HF). Statistical analysis of the data was performed using SPSS 26.0 software. Results: At night, RMSSD (F=6.694) and HF (F=9.434) were lower in the VM and migraine groups compared to the control group, while LF/HF (F=16.049) and LF (F=9.434) were elevated compared to the control group, with statistically significant differences (P<0.05 or P<0.01), while LF was significantly elevated in the VM group compared to the migraine group, with a statistically significant (P<0.05). On the daytime measurements, mainly LF was elevated in the vestibular migraine group compared with the control group, while RMSSD was decreased compared with the control group, with statistically significant differences (P<0.05). Conclusion: Autonomic dysfunction characterized by sympathetic hyperfunction and vagal hypofunction is present in VM patients and is more pronounced at night. In addition, the degree of autonomic dysfunction may be more pronounced in VM patients than in migraine patients.

Adult , Female , Heart Rate/physiology , Humans , Male , Middle Aged , Migraine Disorders , Vertigo
Journal of Integrative Medicine ; (12): 213-220, 2022.
Article in English | WPRIM | ID: wpr-929225


BACKGROUND@#Acupuncture has been widely used to relieve migraine-related symptoms. However, the findings of previous systematic reviews (SRs) and meta-analyses (MAs) are still not completely consistent. Their quality is also unknown, so a comprehensive study is needed.@*OBJECTIVE@#To evaluate the reporting and methodological quality of these MAs concerning acupuncture for migraine, and summarize evidence about the efficacy and safety of acupuncture for migraine.@*SEARCH STRATEGY@#PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Databases, Wanfang Data, and VIP databases were searched from inception to September 2020, with a comprehensive search strategy.@*INCLUSION CRITERIA@#The pairwise MAs of randomized controlled trials (RCTs) concerning migraine treated by acupuncture or acupuncture-based therapies, with a control group that received sham acupuncture, medication, no treatment, or acupuncture at different acupoints were included.@*DATA EXTRACTION AND ANALYSIS@#Two independent investigators screened studies, extracted relevant data, and assessed reporting and methodological quality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 and A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), then all results were cross-checked. Spearman correlation test was used to evaluate the correlation between reporting and methodological quality scores.@*RESULTS@#A total of 20 MAs were included in this study. The included MAs indicated that acupuncture was efficacious and safe in preventing and treating migraine when compared with control intervention. There was a high correlation between reporting and methodological quality scores (rs = 0.87, P < 0.001). The quality of the included SRs needs to be improved mainly with regard to protocol and prospective registration, using a comprehensive search strategy, summarizing the strength of evidence body for key outcomes, a full list of excluded studies with reasons for exclusion, reporting of RCTs' funding sources, and assessing the potential impact of risk of bias in RCTs on MA results.@*CONCLUSION@#Acupuncture is an effective and safe intervention for preventing and treating migraine, and could be considered as a good option for patients with migraine. However, the reporting and methodological quality of MAs included in this overview is suboptimal. In the future, AMSTAR 2 and PRISMA tools should be followed when making and reporting an SR with MA.

Acupuncture Points , Acupuncture Therapy/methods , China , Humans , Meta-Analysis as Topic , Migraine Disorders/therapy , Research Report
Article in Chinese | WPRIM | ID: wpr-939537


Professor WU Zhong-chao's clinical experience of "dredging stagnation and collaterals" acupuncture for migraine is summarized. Professor WU proposes that occiput-nape dysfunction, meridians-tendons dysfunction and stagnation of collaterals due to obstruction of excess-evil could lead to migraine. As such, migraine is treated by comprehensive treatment of adjusting occiput-nape functional zone, relaxing meridians-tendons and blood-letting combined with fire acupuncture.

Acupuncture , Acupuncture Points , Acupuncture Therapy , Humans , Meridians , Migraine Disorders/therapy
Article in Chinese | WPRIM | ID: wpr-928080


This study systematically sorted out the existing studies about Tianshu Capsules in the treatment of migraine(syndrome of blood stasis blocking collaterals, syndrome of ascendant hyperactivity of liver Yang), and conducted comprehensive clinical evaluation through "6+1" dimensions of safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine(TCM) to embody the advantages and characteristics and clarify the precise clinical position of Tianshu Capsules. The value of each dimension was calculated via health technology assessment, the multi-criteria decision analysis(MCDA) mo-del and CSC v2.0 software. The results were graded into four levels of A, B, C, or D from high to low. According to the available studies, Tianshu Capsules had low and controllable risks, with the safety rated as A. The drug has obvious clinical significance in the treatment of migraine(syndrome of blood stasis blocking collaterals, syndrome of ascendant hyperactivity of liver Yang), with the effectiveness rated as A. It has clear economic results, with the economy rated as B. The clinical innovation, service system innovation, and industrial innovation are all good, and thus the innovation of Tianshu Capsules is grade A. The drug can meet clinical medication demand of medical care and patients, and thus its suitability is grade A. In view of the reasonable drug price, affordability, and availability, the accessibility is grade A. The prescription originated from the Daxiong Pills recorded in the classic Comprehensive Recording of Sage-like Benefit. In clinical trials, 4 675 patients have used Tianshu Capsules, which indicates rich experience in human administration, and the characteristics of traditional Chinese medicine is grade B. The statutory drug information complies with national stan-dards, and the non-statutory information is standard and accurate. Based on the comprehensive evaluation results of various dimensions of evidence, the clinical value of Tianshu Capsules in the treatment of migraine(syndrome of blood stasis blocking collaterals and syndrome of ascendant hyperactivity of liver Yang) is class A. According to the Comprehensive Clinical Evaluation Management Guidelines of Drugs(trial version 2021) issued by the National Health Commission of the People's Republic of China, we recommend that Tianshu Capsules treating migraine can be transformed into relevant policy results for clinical medication management according to procedures.

Capsules , Humans , Liver , Medicine, Chinese Traditional , Migraine Disorders/drug therapy , Syndrome
Article in Chinese | WPRIM | ID: wpr-927414


OBJECTIVE@#To compare the clinical effect of electroacupuncture at Siguan points and flunarizine hydrochloride capsule on migraine of liver yang hyperactivity.@*METHODS@#A total of 110 patients with migraine of liver yang hyperactivity were randomly divided into an electroacupuncture group (55 cases, 2 cases dropped off) and a western medication group (55 cases, 2 cases dropped off). In the electroacupuncture group, electroacupuncture was applied at Siguan points (Hegu [LI 4] and Taichong [LR 3]), with disperse-dense wave of 2 Hz/100 Hz in frequency and current intensity of 0.1-1 mA, 30 min each time, once a day, 5 times per week for 4 weeks. Flunarizine hydrochloride capsule was given orally in the western medication group, 10 mg a day for 4 weeks. The visual analogue scale (VAS) score and the migraine attack days were observed before and after treatment, during follow-up of 1, 3 and 6 months, and the migraine symptom score was observed before and after treatment in the two groups.@*RESULTS@#After treatment, during follow-up of 1, 3 and 6 months, the VAS scores and the migraine attack days in the two groups were decreased compared with before treatment (P<0.05), and above indexes in the electroacupuncture group were lower than the western medication group (P<0.05). After treatment, the migraine symptom scores in the two groups were decreased (P<0.05), the change in the electroacupuncture group was greater than the western medication group (P<0.05).@*CONCLUSION@#Electroacupuncture at Siguan points could effectively reduce headache intensity and migraine attack days, relieve migraine symptoms in patients with migraine of liver yang hyperactivity, and the efficacy is superior to oral flunarizine hydrochloride capsules.

Acupuncture Points , Electroacupuncture , Flunarizine/therapeutic use , Humans , Liver , Migraine Disorders/therapy
Article in Chinese | WPRIM | ID: wpr-927340


Regarding the development of international standard of Guideline for Clinical Practice of Acupuncture and Moxibustion: Migraine, the existing problems of the design and methodology of randomized controlled trial (RCT) on acupuncture and moxibustion for migraine were summarized in views of participant, intervention, control, outcome and study design. Four directions need to be further explored, (1) research of adolescent migraine, special subtype of migraine and migraine in a special population; (2) research of the immediate analgesic effect of acupuncture and moxibuation at the attack stage of migraine and the therapeutic effect of migraine at each stage; (3) research on safety and health economics; (4) clinical trial registration of acupuncture and moxibustion. In study, the target population should be further determined and specialized, the diagnosis criteria of western medicine and traditional Chinese medicine be generalized and concentrated, the staging and type division of disease be accurate, the intervention procedure be integrated, the control design be rationalized, the outcomes be validated, and the description of randomization and blinding be clarified.

Acupuncture , Acupuncture Therapy , Adolescent , Humans , Medicine, Chinese Traditional , Migraine Disorders/therapy , Moxibustion
Int. j. morphol ; 40(4): 1067-1074, 2022. ilus, tab
Article in English | LILACS-Express | LILACS | ID: biblio-1405252


SUMMARY: This paper was aimed to determine the morphometric measurements of cerebellum using MRI in subjects having migraine, ataxia, dementia and vertigo. Three hundred twenty six (326 subjects; 80 migraine subjects; 85 vertigo subjects; 83 dementia subjects; 78 ataxia subjects) subjects ranging from 20 up to 85 years were included in this study. Cerebellum morphometric measurements were taken from subjects having brain MRI in the Radiology Department. The means and standard deviations of the measurements were: Sagittal section cerebellum superior inferior length, 56.21±5.16 mm; sagittal section cerebellum anteroposterior length, 86.36 ±5.36 mm; axial section cerebellum antereoposterior length, 66.53±5.41 mm; axial section bi-cerebellar length, 100.48±5.14 mm; coronal section cerebellum supero-inferior length,53.60±3.84 mm; coronal section bi-cerebellar length, 99.77±6.24 mm in subjects with migraine, whereas the corresponding values were 62.33±8.66 mm; 93.31±9.89 mm; 60.26±7.98 mm; 99.89±6.41 mm; 54.35±4.64 mm; 85.58±14.74 mm in subjects with vertigo, respectively. The same values were found as 58.82±8.34 mm; 86.74±13.22 mm; 58.93±8.89 mm; 97.93±6.07 mm; 50.66±4.92 mm; 84.96±14.93 mm in patients having dementia, respectively, while the same measurements were as 60.83±8.59 mm; 92.18±9.12 mm; 57.76±7.85 mm; 97.71±5.82 mm; 52.48±4.85 mm; 81.49±14.38 mm in ataxia patients, respectively. Also, ages were divided into seven groups as decades. There were found significant difference in all parameters according to sex and ages (p<0.05). The cerebellum morphometry provides important and useful knowledge in terms of comparison of abnormalities clinicians and data will be valuable for the determination of pathologies for clinical disciplines.

RESUMEN: Este trabajo tuvo como objetivo determinar las medidas morfométricas del cerebelo mediante resonancia magnética en sujetos con migraña, ataxia, demencia y vértigo. Trescientos veintiseis sujetos (80 con migraña; 85 con vértigo; 83 con demencia y 78 con ataxia) entre los 20 y los 85 años de edad se incluyeron en este estudio. Se tomaron medidas morfométricas del cerebelo de sujetos sometidos a resonancia magnética en el Departamento de Radiología. Las medias y desviaciones estándar de las medidas fueron: sección sagital longitud superoinferior del cerebelo, 56,21±5,16 mm; sección sagital longitud anteroposterior del cerebelo, 86,36 ±5,36 mm; sección axial longitud anteroposterior del cerebelo, 66,53±5,41 mm; sección axial longitud bicerebelosa, 100,48±5,14 mm; sección coronal longitud superoinferior del cerebelo, 53,60±3,84 mm; longitud bicerebelosa de la sección coronal, 99,77±6,24 mm en sujetos con migraña, mientras que los valores correspondientes fueron 62,33±8,66 mm; 93,31±9,89mm; 60,26±7,98 mm; 99,89±6,41 mm; 54,35±4,64 mm; 85,58±14,74 mm en sujetos con vértigo, respectivamente. Se encontraron los mismos valores para pacientes con demencia 58,82±8,34 mm; 86,74±13,22 mm; 58,93±8,89 mm; 97,93±6,07 mm; 50,66±4,92 mm; 84,96±14,93 mm , respectivamente, mientras que las mismas medidas fueron de 60,83±8,59 mm; 92,18±9,12 mm; 57,76±7,85 mm; 97,71±5,82 mm; 52,48±4,85 mm; 81,49±14,38 mm en pacientes con ataxia, respectivamente. Las edades se dividieron en siete grupos, cada uno en década. Se encontraron diferencias significativas en todos los parámetros según sexo y edad (p<0,05). La morfometría del cerebelo proporciona un conocimiento importante y útil en términos de comparación de anormalidades clínicas y los datos serán valiosos para la determinación de patologías para las disciplinas clínicas.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Cerebellum/diagnostic imaging , Ataxia , Magnetic Resonance Imaging , Cerebellum/anatomy & histology , Sex Factors , Vertigo , Age Factors , Dementia , Migraine Disorders
Braz. j. otorhinolaryngol. (Impr.) ; 87(6): 671-677, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1350350


Abstract Introduction: Vestibular migraine as an entity was described in 1999 and its pathophysiology is still not established. Simultaneously with research to better understand vestibular migraine, there has been an improvement in vestibular function assessment. The video-head impulse test is one of the latest tools to evaluate vestibular function, measuring its vestibular-ocular reflex gain. Objective: To evaluate vestibular function of vestibular migraine patients using video-head impulse test. Methods: Cross-sectional case-control study homogeneous by age and gender with vestibular migraine patients according to the 2012-2013 Barany Society/International Headache Society diagnostic criteria submitted to video-head impulse test during intercrisis period. Results: 31 vestibular migraine patients were evaluated with a predominantly female group (90.3%) and mean age of 41 years old. Vestibular function was normal in both patient and control groups. Gain values for horizontal canals were similar between the two groups, but gain values for vertical canals were higher in the group with vestibular migraine (p < 0.05). Patients with vestibular migraine felt more dizziness while performing the video-head impulse test than control subjects (p < 0.001). Conclusions: Patients with vestibular migraine present normal vestibular function during intercrisis period when evaluated by video-head impulse test. Vertical canals, however, have higher gains in patients with vestibular migraine than in control subjects. Vestibular migraine patients feel dizziness more often while conducting video-head impulse test.

Resumo Introdução: A enxaqueca vestibular foi descrita como uma entidade em 1999 e sua fisiopatologia ainda não está estabelecida. Simultaneamente às pesquisas para entender melhor essa condição clínica, houve uma melhoria na avaliação da função vestibular. O teste de impulso cefálico por vídeo, vHIT, é uma das mais recentes ferramentas para avaliar a função vestibular, mede seu ganho do reflexo vestíbulo-ocular. Objetivo: Avaliar com o vHIT a função vestibular de pacientes com enxaqueca vestibular. Método: Estudo transversal de caso-controle, homogêneo em relação a idade e sexo, de pacientes com enxaqueca vestibular, de acordo com os critérios de diagnóstico da Barany Society/International Headache Society de 2012-2013, submetidos ao vHIT durante o período intercrises. Resultados: Foram avaliados 31 pacientes com enxaqueca vestibular com um grupo predominantemente feminino (90,3%) e média de 41 anos. A função vestibular era normal nos grupos paciente e controle. Os valores de ganho para canais horizontais foram semelhantes entre os dois grupos, mas os valores de ganho para canais verticais foram maiores no grupo com enxaqueca vestibular (p < 0,05). Pacientes com enxaqueca vestibular sentiram mais tontura ao fazer o vHIT do que os controles (p < 0,001). Conclusões: Pacientes com enxaqueca vestibular apresentam função vestibular normal durante o período intercrises quando avaliados pelo vHIT. Os canais verticais, no entanto, apresentam ganhos maiores em pacientes com enxaqueca vestibular do que em indivíduos controle. Pacientes com enxaqueca vestibular sentem tontura com maior frequência enquanto fazem o vHIT.

Humans , Female , Adult , Head Impulse Test , Migraine Disorders/diagnosis , Reflex, Vestibulo-Ocular , Case-Control Studies , Semicircular Canals , Vertigo , Cross-Sectional Studies
Arq. neuropsiquiatr ; 79(10): 886-890, Oct. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345326


ABSTRACT Background: Botulinum toxin Type A (BoNTA) is a successful treatment for chronic migraine prophylaxis. Objective: We aimed to evaluate the monthly change of effectiveness of BoNTA treatment. Methods: A total of 80 patients (70 females and 10 males) with chronic migraine were included. In our study protocol, we applied to 155 U across 31 fixed-sites and if the patient had pain, 40 U dose injections were applied across 8 specific head/neck muscle areas. Headache days and analgesic intake were noted before the BoNTA injection and during the interviews at the first, second, and third months after the BoNTA injection. Results: The mean age was 37.59 ± 7.60 and 87.5% of the patients were female. The mean number of headache days/month before BoNTA was 18.95±2.69, decreasing to 10.55±3.15 days/month in the first month (p<0.001), 9.31±2.43 days/month in the second month (p<0.001), and increased to 11.97±3.27 days/month in the third month (p<0.001). The mean analgesic intake before BoNTA was 11.48±4.68 tablets/month, while it decreased to 6.53±2.72 tablets/month in the first month (p<0.001) and 5.40±2.46 tablets/month in the second month (p<0.001). In the third month, it was 5.85±2.59 tablets/month (p<0.001). There was a significant increase in pain medication use from the second to the third month (p<0.001). Conclusion: In our study, there was a significant reduction in analgesic intake and headache days in the first and second months after BoNTA injection, and an increase was observed in the third month.

RESUMO Antecedentes: A toxina botulínica Tipo A (BoNTA) é um tratamento de sucesso para a profilaxia da migrânea crônica. Objetivo: Nosso objetivo foi avaliar a mudança mensal da eficácia do tratamento com BoNTA. Métodos: Um total de 80 pacientes (70 mulheres e 10 homens) com migrânea crônica foi incluído. Em nosso protocolo de estudo, aplicamos 155 U em 31 locais fixos e, se o paciente sentisse dor, injeções de dose de 40 U foram aplicadas em 8 áreas musculares específicas da cabeça/pescoço. Dias de cefaleia e ingestão de analgésicos foram anotados antes da injeção de BoNTA e durante as entrevistas no primeiro, segundo e terceiro meses após a injeção de BoNTA. Resultados: A média de idade foi 37,59±7,60 e 87,5% dos pacientes eram do sexo feminino. O número médio de cefaleias dias/mês antes da BoNTA foi de 18,95±2,69 dias/mês, diminuindo para 10,55±3,15 dias/mês no primeiro mês (p<0,001), 9,31±2,43 dias/mês no segundo mês (p<0,001), e aumentou para 11,97±3,27 dias/mês no terceiro mês (p<0,001). A ingestão média de analgésicos antes da BoNTA foi de 11,48±4,68 comprimidos/mês, enquanto diminuiu para 6,53±2,72 comprimidos/mês no primeiro mês (p<0,001) e 5,40±2,46 comprimidos/mês no segundo mês (p<0,001). No terceiro mês, era de 5,85±2,59 comprimidos/mês (p<0,001). Quando comparados o segundo e o terceiro mês, observou-se aumento significativo do uso de analgésicos do segundo para o terceiro mês (p<0,001). Conclusão: Em nosso estudo, houve redução significativa da ingestão de analgésicos e dos dias de cefaleia no primeiro e segundo meses após a injeção de BoNTA, e aumento no terceiro mês.

Humans , Male , Female , Adult , Botulinum Toxins, Type A , Migraine Disorders/drug therapy , Neuromuscular Agents , Treatment Outcome , Analgesics , Middle Aged
Arq. neuropsiquiatr ; 79(9): 789-794, Sept. 2021. tab
Article in English | LILACS | ID: biblio-1345328


Abstract Background: Migraines are headaches caused by changes in the trigeminovascular metabolic pathway. Migraine headache attacks are associated with neurovascular inflammation, but their pathophysiological mechanisms have not been fully explained. Objective: To investigate the relationship between serum vaspin, visfatin, chemerin and interleukin-18 (IL-18) levels and the frequency of attacks in migraine headache. Methods: Three groups were established: migraine with aura (n = 50), migraine without aura (n = 50) and control group (n = 50). The migraine diagnosis was made in accordance with the International Classification of Headache Disorders-III beta diagnostic criteria. The analyses on serum vaspin, visfatin, chemerin and IL-18 levels were performed using the enzyme-linked immunosorbent assay method. Results: The serum vaspin, visfatin, chemerin and IL-18 levels were found to be significantly higher in the migraine patients than in the control group (p < 0.01). No statistically significant differences in serum vaspin, visfatin, chemerin and IL-18 levels were found among the migraine patients during attacks or in the interictal period (p>0.05). The serum visfatin and chemerin levels of the migraine patients were positively correlated with their serum IL-18 levels (p < 0.01), while their serum chemerin and visfatin levels were positively correlated with their serum vaspin levels (p < 0.05). Conclusions: This study showed that these biomarkers may be related to migraine pathogenesis. Nonetheless, we believe that more comprehensive studies are needed in order to further understand the role of vaspin, visfatin, chemerin and IL-18 levels in the pathophysiology of migraine headaches.

Resumo Introdução: A migrânea é causada por alterações nas vias metabólicas do sistema trigeminovascular. Crises de migrânea estão associadas à inflamação neurovascular, mas seus mecanismos patofisiológicos ainda não são totalmente explicados. Objetivo: Investigar a relação entre níveis séricos de vaspina, visfatina, quemerina e interleucina-18 (IL-18) e a frequência de crises de migrânea. Métodos: Três grupos foram formados: migrânea com aura (n = 50), migrânea sem aura (n = 50) e grupo controle (n = 50). A migrânea foi diagnosticada de acordo com os critérios da Classificação Internacional das Cefaleias (ICHD-III). As análises dos níveis séricos de vaspina, visfatina, quemerina e IL-18 foram realizadas utilizando-se o método imunoenzimático (ELISA). Resultados: Os níveis séricos de vaspina, visfatina, quemerina e interleucina-18 (IL-18) foram significativamente mais elevados em pacientes com migrânea do que no grupo controle (p < 0.01). Nenhuma diferença estatisticamente significativa foi observada nos níveis séricos de vaspina, visfatina, quemerina e interleucina-18 (IL-18) entre os pacientes com migrânea durante crises ou no período interictal (p>0,05). Os níveis séricos de visfatina e quemerina em pacientes com migrânea se correlacionaram positivamente com os níveis séricos de IL-18 (p < 0,01), ao passo que os níveis séricos de quemerina e visfatina se correlacionaram positivamente com os níveis séricos de vaspina (p < 0,05). Conclusões: Este estudo demonstrou que estes biomarcadores podem estar relacionados à patogênese da migrânea. Contudo, acreditamos que estudos mais abrangentes são necessários a fim de melhor compreendermos o papel dos níveis de vaspina, visfatina, quemerina e IL-18 na fisiopatologia da migrânea.

Humans , Insulin Resistance , Serpins , Migraine Disorders , Chemokines , Interleukin-18 , Nicotinamide Phosphoribosyltransferase
Arq. neuropsiquiatr ; 79(8): 682-685, Aug. 2021.
Article in English | LILACS | ID: biblio-1339232


ABSTRACT Background: Catastrophization is a psychological aspect of pain that alters its perception and expression. Objective: To investigate the feature of catastrophization in migraine. Methods: An online survey of individuals suffering from migraine attacks at least twice a month, for at least one year was carried out. Confidentiality was assured and participants gave details of their headache (including a visual analogue pain scale) and answered the Hospital Anxiety and Depression Scale and the Catastrophization Scale questionnaires. Results: The survey included 242 individuals with migraine attacks at least twice a month. The median scores observed in this group of individuals were 7 for pain, 11 for anxiety, 7 for depression, and 2 for catastrophization. Catastrophization had no correlation with the duration (p=0.78) or intensity (p=0.79) of the migraine. There was no correlation between catastrophization and headache frequency (p=0.91) or the monthly amount of headache medication taken (p=0.85). High scores for catastrophization (≥3.0) were identified in one third of the participants. These high scores were not associated with age, headache duration, pain severity, frequency of attacks, or traits of depression or anxiety. There was a moderate association between both depression and anxiety traits with catastrophization. Conclusions: Catastrophization seems to be a trait of the individual and appears to be unrelated to the characteristics of the migraine.

RESUMO Antecedentes: A catastrofização é um aspecto psicológico da dor, alterando sua percepção e expressão. Objetivos: Investigar o fenômeno da catastrofização na enxaqueca. Métodos: Pesquisa online com indivíduos que sofrem de crises de enxaqueca pelo menos duas vezes por mês, por pelo menos um ano. O sigilo foi assegurado. O participante dava detalhes de sua dor de cabeça (incluindo escala de dor analógica visual) e respondeu à Escala de Ansiedade e Depressão Hospitalar e à Escala de Catastrofização. Resultados: A pesquisa identificou 242 indivíduos com ataques de enxaqueca pelo menos duas vezes por mês. Os escores medianos observados neste grupo de indivíduos foram 7 para dor, 11 para ansiedade, 7 para depressão e 2 para catastrofização. Catastrofização não teve correlação com a duração (p=0,78) ou intensidade (p=0,79) da dor na crise de enxaqueca. Não houve correlação entre catastrofização e frequência de crises (p=0,91) ou quantidade mensal de medicação usada para tratar a cefaleia (p=0,85). Foram identificados escores elevados para catastrofização (≥3,0) em um terço dos participantes. Esses escores elevados não foram associados à idade, duração da dor de cabeça, gravidade da dor, frequência de ataques e traços de depressão ou de ansiedade. Houve moderada associação entre casos com concomitante depressão e ansiedade e catastrofização. Conclusões: A catastrofização parece ser um traço do indivíduo e parece não estar relacionada às características da enxaqueca.

Humans , Catastrophization , Migraine Disorders , Anxiety/epidemiology , Confidentiality , Depression/epidemiology
Medicina (B.Aires) ; 81(3): 427-431, jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346480


Resumen La migraña es un trastorno muy prevalente que afecta a alrededor del 15% de los sujetos adultos. Es clasificada por la Organización Mundial de la Saludentre los primeros puestos como causa de discapacidad. Los tratamientos preventivos habituales hasta ahora derivan de otras indicaciones y por serendipia se utilizan en prevención de migraña: betabloqueantes, drogas antiepilépticas, antidepresivos tricíclicos, bloquean tes de canales de calcio, toxina botulínica. Todas ellas han mostrado eficacia similar al 50% en reducir el número de episodios migrañosos pese a efectos secundarios indeseados. Durante los últimos años, se ha evaluado la eficacia y seguridad de los anticuerpos monoclonales (AM) que actúan sobre la vía del péptido relacionado con el gen de la calcitonina (CGRP) en migraña. Dicho péptido es relevante en la activación del dolor en territorio meníngeoy es mediado por terminales nerviosas trigeminales una vez activado el proceso migrañoso. Su dosaje en crisis migrañosas ha sido elevado en diversos estudios y su neutralización/bloqueo, redunda en alivio del dolor. Los anticuerpos monoclonales erenumab, galcanezumab, fremanezumab, eptinezumab aprobados en el mercado EE.UU./Europa desde 2018 y tras varios trabajos de Fase III y abiertos de extensión, mostraron clara seguridad yeficacia y están presentes en nuestro medio desde mediados de 2019. Desarrollamos la racionalidad e indicaciones de uso de los mismos.

Abstract Migraine is a very prevalent disorder that is estimated to affect about 10-15% of adult subjects. Ac cording to the World Health Organization migraine is one of the first causes of disability. Traditional preventive treatments discovered by serendipity include Beta blockers, antinconvulsants drugs, calcium channel blockers, tricyclic antidepressants and onabotulinum A and offer about 50% efficacy after controlled placebo trials and real life use. Because of lack of adherence and adverse events, there is a loss of beneficial sustain on these treat ments. Recently, the efficacy and safety of monoclonal antibodies (MA) that act on the peptide pathway related to the calcitonin gene (CGRP) has been evaluated in migraine, being the first specific tailored treatment on one of the multiple targets on migraine. This family of drugs: erenumab, galcanezumab, fremanezumab, eptinezumab, finished Fase III, extensions trials and many of them are in the market approved since 2018.Since 2019 are available in Argentina. We will describe the rationale for the prescription of this family of new drugs for migraine.

Humans , Adult , Antineoplastic Agents, Immunological/therapeutic use , Migraine Disorders/prevention & control , Migraine Disorders/drug therapy , Argentina , Calcitonin Gene-Related Peptide Receptor Antagonists/therapeutic use , Antibodies, Monoclonal/therapeutic use
Arq. neuropsiquiatr ; 79(6): 483-488, June 2021. tab, graf
Article in English | LILACS | ID: biblio-1285363


Abstract Background: Migraine is a prevalent neurological disease that leads to severe headaches. Moreover, it is the commonest among the primary headaches that cause medication overuse headache (MOH). The orbitofrontal cortex (OFC) is one of the structures most associated with medication overuse. Objective: To determine microstructural changes in the OFC among migraine patients who developed MOH, through the diffusion tensor imaging (DTI) technique. Methods: Fifty-eight patients who had been diagnosed with migraine based on the Classification of Headache Disorders (ICHD-III-B) were included in the study. Patients were sub-classified into two groups, with and without MOH, based on the MOH criteria of ICHD-III-B. DTI was applied to each patient. The OFC fractional anisotropy (FA), and apparent diffusion coefficient (ADC) values of the two groups were compared. Results: The mean age of all the patients was 35.98±7.92 years (range: 18-65), and 84.5% (n=49) of them were female. The two groups, with MOH (n=25) and without (n=33), were alike in terms of age, gender, family history, migraine with or without aura and duration of illness. It was found that there was a significant difference in FA values of the left OFC between the two groups (0.32±0.01 versus 0.29±0.01; p=0.04). Conclusions: An association was found between MOH and changes to OFC microstructure. Determination of neuropathology and factors associated with medication overuse among migraine patients is crucial in terms of identifying the at-risk patient population and improving proper treatment strategies specific to these patients.

RESUMO Introdução: A migrânea é uma doença neurológica prevalente que causa fortes dores de cabeça. Além disso, é a mais comum entre as cefaleias primárias que causam cefaleia por uso excessivo de medicamentos (CUEM). O córtex orbitofrontal (OF) é uma das estruturas mais associadas ao uso excessivo de medicamentos. Objetivo: Determinar alterações microestruturais no córtex OF em pacientes com migrânea que desenvolveram CUEM, por meio da técnica de imagem por tensor de difusão (ITD). Métodos: Cinquenta e oito pacientes com diagnóstico de migrânea, com base na Classificação das Cefaleias (ICHD-III-B), foram incluídos no estudo. Os pacientes foram subclassificados em dois grupos, com e sem CUEM, com base nos critérios de CUEM da ICHD-III-B. A ITD foi aplicada a cada paciente. Os valores de anisotropia fracionada OFC (AF) e coeficiente de difusão aparente (CDA) dos dois grupos foram comparados. Resultados: A média de idade de todos os pacientes foi de 35,98±7,92 anos (variação: 18‒65), sendo 84,5% (n=49) do sexo feminino. Os dois grupos, com CUEM (n=25) e sem (n=33), são semelhantes em termos de idade, sexo, história familiar, migrânea com ou sem aura e duração da doença. Verificou-se que houve diferença significativa nos valores de AF do córtex OF esquerdo entre os dois grupos (0,32±0,01 versus 0,29±0,01; p=0,04). Conclusões: Foi encontrada associação entre o CUEM e as alterações na microestrutura do córtex OF. A determinação da neuropatologia e dos fatores associados ao uso excessivo de medicamentos entre pacientes com migrânea é crucial para identificar a população de pacientes em risco e melhorar as estratégias de tratamento adequadas específicas para esses pacientes.

Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Headache Disorders, Secondary/diagnostic imaging , Migraine Disorders/drug therapy , Migraine Disorders/diagnostic imaging , Prefrontal Cortex , Diffusion Tensor Imaging , Prescription Drug Overuse , Middle Aged
Arq. neuropsiquiatr ; 79(5): 399-406, May 2021. tab, graf
Article in English | LILACS | ID: biblio-1278396


ABSTRACT Background: Migraine is one of the most frequent and incapacitating headaches, with a high degree of impairment of balance control and postural stability. Objective: To investigate the effects of episodic and chronic migraine on postural balance through using static and dynamic balance tests. Methods: The study included 32 chronic and 36 episodic migraine patients and a control group of 36 healthy volunteers. Right/left single-leg static and dynamic balance tests were performed in each group with eyes open and closed using a posturographic balance platform (Techno-body Prokin). Results: No significant difference was found among episodic and chronic migraine patients and control subjects with regard to eyes-open and eyes-closed area values (eyes-open area values: p=0.559, p=0.414 and p=0.906; eyes-closed area values: p=0.740, p=0.241 and p=0.093, respectively). However, the area values were significantly higher in episodic and chronic migraine patients than in the control group, which indicates that migraine patients may have lower balance performance. Perimeter values were relatively higher which supports the idea that migraine patients have lower balance performance. Additionally, the average number of laps was significantly lower among migraine patients than in the control group, which also implies that migraine patients may have lower balance performance. Conclusion: Although no significant difference was detected between chronic and episodic migraine patients and the control group and between chronic and episodic migraine patients with regard to balance performance, chronic migraine patients seemed to have relatively lower performance than episodic migraine patients. Further studies with larger numbers of patients are needed, to investigate the relationship between these parameters and balance.

RESUMO Introdução: A enxaqueca é uma das dores de cabeça mais frequentes e incapacitantes, com alto grau de comprometimento do controle do equilíbrio e estabilidade postural. Objetivo: Investigar os efeitos da enxaqueca episódica e crônica no equilíbrio postural por meio de testes de equilíbrio estático e dinâmico. Métodos: O estudo incluiu 32 pacientes com enxaqueca crônica e 36 com enxaqueca episódica e um grupo controle de 36 voluntários saudáveis. Os testes de equilíbrio estático e dinâmico unipodal direito/esquerdo foram realizados em cada grupo, com os olhos abertos e fechados, por meio de uma plataforma de equilíbrio posturográfico (Techno-body Prokin). Resultados: Nenhuma diferença significativa foi encontrada entre pacientes com enxaqueca episódica e crônica e indivíduos controle em relação aos valores da área de olhos abertos e olhos fechados (valores de área de olhos abertos: p=0,559, p=0,414 e p=0,906; valores de área de olhos fechados: p=0,740, p=0,241 e p=0,093, respectivamente). No entanto, os valores de área foram significativamente maiores em pacientes com enxaqueca episódica e crônica do que no grupo controle, o que indica que pacientes com enxaqueca podem ter desempenho de equilíbrio inferior. Os valores do perímetro foram relativamente mais altos, o que sustenta a hipótese de que os pacientes com enxaqueca apresentam desempenho de equilíbrio inferior. Além disso, o número médio de voltas foi significativamente menor entre os pacientes com enxaqueca do que no grupo controle, o que também implica que os pacientes com enxaqueca possam ter um desempenho de equilíbrio inferior. Conclusão: Embora nenhuma diferença significativa tenha sido detectada entre os pacientes com enxaqueca crônica e episódica e o grupo controle e entre os pacientes com enxaqueca crônica e episódica no que diz respeito ao desempenho do equilíbrio, os pacientes com enxaqueca crônica parecem ter um desempenho relativamente inferior do que os pacientes com enxaqueca episódica. Outros estudos com maior número de pacientes são necessários para investigar a relação entre esses parâmetros e o equilíbrio.

Humans , Postural Balance , Migraine Disorders , Lower Extremity , Healthy Volunteers
Braz. j. otorhinolaryngol. (Impr.) ; 87(1): 35-41, Jan.-Feb. 2021. graf
Article in English | LILACS | ID: biblio-1153584


Abstract Introduction: Vestibular migraine is a condition that associates headache and vestibular symptoms. Objective: To evaluate body-balance with virtual reality posturography in vestibular migraine. Methods: A total of 26 patients in the intercritical period of vestibular migraine were compared by means of the Balance Rehabilitation UnitMT (Medical/Interacoustics) posturography with 30 controls, paired for age and gender. Results: There was no significant statistical difference (p = 0.121) in the limit of stability area (cm2) between the experimental group and the control group values. There were significant differences (p < 0.05) in the values of sway velocity (cm/s) in nine of ten evaluated sensory conditions and in the pressure center displacement area (cm2) values in eight of those ten sensory conditions in the comparison between the control group and the experimental group. Conclusion: Posturography with virtual reality can identify changes in the sway velocity and the pressure center displacement area, characterizing the inability to maintain postural control with and without visual deprivation in situations of visual conflict and vestibulovisual interaction,in the intercritical period of the vestibular migraine.

Resumo Introdução: A migrânea vestibular é um quadro clínico que associa cefaleia migranosa e sintomas vestibulares. Objetivo: Avaliar o controle postural à posturografia com realidade virtual no período intercrítico da migrânea vestibular. Método: Um total de 26 pacientes com migrânea vestibular no período intercrítico da afecção foram comparados comparados à posturografia do Balance Rehabilitation UnitTM (Medical/Interacoustics) a um grupo controle com 30 indivíduos hígidos pareados por idade e sexo. Resultados: Não houve diferença estatisticamente significante (p = 0,102) entre os valores da área do limite de estabilidade (cm2) entre o grupo experimental e o controle. Houve diferença significante (p < 0,05) nos valores da velocidade de oscilação (cm/s) em nove de dez condições sensoriais avaliadas e nos valores da área de deslocamento do centro de pressão (cm2) em oito destas dez condições sensoriais em comparação entre os grupos controle e experimental. Conclusão: A posturografia com realidade virtual pode identificar alterações da velocidade de oscilação e da área de deslocamento do centro de pressão, o que caracteriza a inabilidade para manter o controle postural com e sem privação da visão, em situações de conflito visual e interação vestibulovisual, no período intercrítico da migrânea vestibular.

Humans , Vestibular Diseases/diagnosis , Virtual Reality , Migraine Disorders/diagnosis , Vertigo/diagnosis , Sensation Disorders , Postural Balance
Article in Chinese | WPRIM | ID: wpr-877668


OBJECTIVE@#To observe the effect of five-element acupuncture on the cognitive function repair of migraine patients with depression/anxiety disorder.@*METHODS@#The migraine patients with depression/anxiety disorder (19 cases, 5 cases dropped off) were taken as the observation group, and received five-element acupuncture twice a week for 8 weeks. Healthy subjects (19 cases) were selected by demographic data matching as the control group. The cognitive function was evaluated with the event related potential (ERP) technique, and the latency and amplitude of visual evoked potential P300 were adopted as the observation indexes. The headache days (every 4 weeks), headache intensity [visual analogue scale(VAS) score], and headache impact test-6 (HIT-6) score, Hamilton depression scale (HAMD) score and Hamilton anxiety scale (HAMA) score were used as the observation indexes for curative effect.@*RESULTS@#Before the treatment, latency of target stimulus at Fz [ (417.5±34.3) ms] in the observation group was extended compared with the healthy subjects of the control group [(388.6±42.1) ms, @*CONCLUSION@#There are some cognitive impairments in migraine patients with depression/anxiety disorder. Five-element acupuncture not only relieves headache, anxiety and depression effectively, but also improves the activation level of the frontal lobe. It significantly repairs the impaired cognitive function.

Acupuncture Points , Acupuncture Therapy , Anxiety Disorders , Cognition , Depression/therapy , Evoked Potentials, Visual , Humans , Migraine Disorders/therapy , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-877558


OBJECTIVE@#To observe the therapeutic effect between acupuncture combined with medication and simple medication on migraine and cerebral hemodynamics.@*METHODS@#A total of 120 patients with migraine were randomized into an acupuncture plus medication group (60 cases, 3 cases dropped off) and a medication group (60 cases, 6 cases dropped off). In the medication group, flunarizine hydrochloride capsule was given orally before sleep, 10 mg a day. On the basis of the treatment in the medication group, acupuncture was applied at Sizhukong (TE 23), Shuaigu (GB 8), Taiyang (EX-HN 5), Fengchi (GB 20) and etc. in the acupuncture plus medication group, 30 min each time, once a day. Treatment for 4 weeks was required in both groups. Before and after treatment, the visual analogue scale (VAS) score, indexes of cerebral hemodynamic [blood flow velocity of anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), vertebral artery (VA) and basilar artery (BA)] and total TCM syndrome score were observed, and the clinical therapeutic effect and the incidence of the adverse events were evaluated in both groups.@*RESULTS@#Compared before treatment, the VAS scores, the blood flow velocity of ACA, MCA, PCA, VA, BA and the total TCM syndrome scores were decreased in both groups (@*CONCLUSION@#Acupuncture combined with flunarizine hydrochloride capsule can effectively relieve the pain in patients with migraine, reduce the cerebral blood flow velocity, the efficacy is superior to simple flunarizine hydrochloride capsule.

Acupuncture Points , Acupuncture Therapy , Hemodynamics , Humans , Migraine Disorders/therapy , Pain , Treatment Outcome
Chinese Acupuncture & Moxibustion ; (12): 1074-1078, 2021.
Article in Chinese | WPRIM | ID: wpr-921012


OBJECTIVE@#To investigate the effect of acupuncture on default mode network (DMN) in migraine patients without aura based on functional Magnetic Resonance Imaging (fMRI).@*METHODS@#Fifteen patients with migraine were included and treated with acupuncture based on "root-knot" theory (Zuqiaoyin [GB 44] for @*RESULTS@#Compared before acupuncture, the functional connections of left parahippocampal cortex (PHC) and anterior medial prefrontal cortex (aMPFC), dorsal medial prefrontal cortex (dMPFC) and lateral temporal cortex (LTC) in DMN after acupuncture were weakened (@*CONCLUSION@#Acupuncture shows good clinical efficacy for migraine without aura, and could adjust the functional connection of DMN.

Acupuncture Therapy , Brain Mapping , Default Mode Network , Humans , Magnetic Resonance Spectroscopy , Migraine Disorders/therapy , Quality of Life
Acta Physiologica Sinica ; (6): 433-445, 2021.
Article in Chinese | WPRIM | ID: wpr-887679


Migraine is a neurological disorder characterized by attacks of moderate or severe headache and various neurological symptoms. Acupuncture, as a commonly used non-pharmacological therapy, has the advantage of obvious therapeutic effect and few side effects in the prevention and treatment of migraine. But the underlying mechanism of acupuncture on migraine remains unclear. Recently, advances in neuroimaging technology have helped to objectively assess the effect of acupuncture on treating migraine and offered new opportunities to explore the central mechanism of acupuncture on treating migraine. In order to better understand the current status of neuroimaging studies on the therapeutic mechanism of acupuncture on migraine and shed light on future research, this review aims to overview the neuroimaging studies in recent 10 years from two aspects: (1) Central mechanism of acupuncture on treating acute migraine attack; (2) Central mechanism of acupuncture on preventing migraine attack.

Acupuncture Therapy , Humans , Migraine Disorders/therapy , Neuroimaging