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Objective:To investigate the underlying neuroimaging mechanism of migraine without aura (MwoA) by using methods of voxel-based morphometry (VBM) and resting-state functional connectivity (FC).Methods:Twenty-five MwoA patients admitted to Department of Neurology, the Second Affiliated Hospital of Xuzhou Medical University from September 2020 to June 2023 were recruited as MwoA group, and 22 volunteers were recruited as healthy control (HC) group. Demographic, clinical characteristics, scores of Hamilton Anxiety Scale (HAMA), Hamilton Depression Rating Scale (HAMD) and Montreal Cognitive Assessment (MoCA) of all subjects were collected; MwoA patients also received Migraine Disability Assessment Questionnaire, Headache Impact Test-6 and headache Visual Analogue Scale assessments. All subjects underwent high-resolution 3D-T 1 and resting-state functional magnetic resonance imaging scanning. The SPM12 software was used to compare the difference in gray matter volume (GMV) between the 2 groups by VBM method. The GRETNA software was adopted to calculate the whole brain FC with anatomical automatic labeling 90 as the regions of interest, and the difference in FC between the 2 groups was statistically analyzed by two-sample t-test. Pearson partial correlation was used to analyze the correlation between brain GMV and FC changes and clinical features and scale scores of MwoA patients. Results:There existed no statistically significant difference between the 2 groups in age, gender, education, scores of HAMA, HAMD and MoCA (all P>0.05). Migraine Disability Assessment Questionnaire, Headache Impact Test-6 and headache Visua Analogue Scale scores of MwoA patients were (8.86±4.55), (50.27±6.35) and (6.68±1.73). Compared with the HC group, GMV was significantly decreased in the right superior frontal gyrus (SFG), right cingulate gyrus (CG) and left thalamus in the MwoA group ( P<0.05, false discovery rate corrected). In addition, the MwoA group showed decreased FC between left thalamus and right cuneus, left lingual gyrus (LG) and bilateral precuneus; decreased FC between right thalamus and right cuneus, right LG and right precuneus; decreased FC between right cuneus and left precuneus and right SFG; decreased FC between left LG and bilateral precuneus, decreased FC between right LG and right precuneus and left SFG; decreased FC between left precuneus and bilateral SFG, and between right precuneus and right SFG (edge P<0.001, component P<0.05, network-based statistics correction, interation=2 000). In MwoA patients, the FC (z-value) between left thalamus and right cuneus was negatively correlated with the duration of disease ( r=-0.530, P=0.011). Conclusions:MwoA patients showed decreased GMV in right SFG, CG and left thalamus. In MwoA patients, FC between thalamus and visual network (VN) and default mode network (DMN) was significantly decreased, and FC among VN, DMN and executive control network was significantly decreased. These changes in brain structure and function may be an adaptive change in the central sensitivity and responsiveness to pain stimuli, and may be an important neuroimaging mechanism of MwoA.
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Objective To observe the abnormal brain activity in patients with migraine without aura(MwoA)with MRI.Methods Fifty MwoA patients(MwoA group)and 46 healthy volunteers(control group)were prospectively enrolled.Functional MRI(fMRI)was performed to observe the dynamic regional homogeneity(dReHo)of brain regions,then brain regions with differences of dReHo value between groups were extracted,and correlations with clinical scales were analyzed.Results Compared with control group,dReHo values of surrounding cortex of bilateral calcarine fissure and right middle occipital gyrus increased,of right middle temporal gyrus,right middle frontal gyrus and left cuneus decreased in MwoA group(GRF correction,voxel level all P＜0.005,cluster level all P＜0.05).The weight analysis showed that brain regions with top 3 absolute weight values were surrounding cortex of right calcarine fissure,left cuneus and right middle occipital gyrus.dReHo value of surrounding cortex of left calcarine fissure in MwoA patients was negative correlated with self-rating depression scale(SDS)(r=-0.28,P=0.04).Conclusion Abnormalities in the upward transmission pathway of visual information existed in MwoA patient,especially in surrounding cortex of right calcarine fissure,left cuneus and right middle occipital gyrus.
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Objetivo : Estimar la frecuencia de migraña, y discapacidad generada en estudiantes de medicina de una universidad privada de Lima Metropolitana. Métodos : Estudio transversal en una muestra no probabilística por conveniencia, mediante la aplicación online del autocuestionario ALCOI-95, para evaluar la presencia de migraña, seguido por el cuestionario MIDAS para medir la discapacidad en los positivos al primer cuestionario. El rendimiento académico fue evaluado mediante el promedio ponderado de sus calificaciones. Resultados : Cuarenticinco (21,6%) de 208 estudiantes experimentaron migraña (12,5% con aura y 9,1% sin aura), 14 (33,3%) de los cuales mostraron discapacidad severa y 12 (28,6%) moderada. Los portadores de migraña con aura tuvieron una media menor del promedio ponderado acumulado de sus calificaciones, comparado con aquellos con migraña sin aura. Los factores independientemente asociados a la migraña fueron tener un miembro de la familia nuclear con migraña y problemas para mantener el sueño. Conclusión : Dos de cada 10 estudiantes presentaron migraña y 1/3 de los afectados experimentó discapacidad severa.
SUMMARY Objective: To estimate the frequency of migraine, associated factors and disability generated (including its relationship with academic performance) in medical students at a private university in Metropolitan Lima. Methods: Cross-sectional study in a non-probabilistic convenience sample using the online application of the ALCOI-95 self-questionnaire, to assess the presence of migraine, followed by the MIDAS questionnaire to measure disability in those positive to the first questionnaire. . Results: Fourty-five (21.6%) of 208 students experienced migraine (12.5% with aura and 9.1% without aura), 14 (33.3%) of whom showed severe, and 12 (28.6%) moderate disability. Migraine with aura carriers had a lower mean than the cumulative weighted average of their academic scores. Independent factors associated with migraine were to have a nuclear family member with migraine, and sleep-maintenance problems. Conclusion: Two out of 10 students had migraine, and one third of them had severe disability.
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Humanos , Adulto , Estudiantes de Medicina , Prevalencia , Migraña con Aura , Migraña sin Aura , Evaluación de la Discapacidad , Estudios TransversalesRESUMEN
Objective:To explore the differences of resting-state spontaneous neural activity between migraine without aura (MwoA) patients with response or nonresponse to non-steroidal anti-inflammatory drugs (NSAIDs), and its correlation with migraine-related features.Methods:From February 2021 to April 2022, thirty MwoA patients with response to NSAIDs, 30 MwoA patients with nonresponse to NSAIDs, and 30 healthy controls were recruited in the Affiliated Jiangning Hospital of Nanjing Medical University.All subjects were scanned with a 3.0 T resting-state functional magnetic resonance imaging scanner.The percent amplitude of fluctuation (perAF) approach was used to calculate the differences of the resting state brain functional activities among the three groups (Bonferroni multiple comparison correction). SPSS 24.0 software and RESTplus software were used for statistical analysis.Analysis of variance was used for the perAF values of three groups.Correlation analysis was performed between perAF values of brain regions with significant differences and migraine-related features.Results:The brain areas showing significant differences of perAF among the three groups located in the left anterior cingulate cortex (ACC)( x, y, z = -6, 9, -3), left middle frontal gyrus (MFG)( x, y, z =-39, 48, 9) and left middle temporal gyrus (MTG)( x, y, z = -57, -30, -15)(all P<0.05, Bonferroni correction). Compared with nonresponse group, the perAF in response group showed significant decreased in the left ACC, MFG and MTG.There was positive correlation between the perAF of left ACC and disease duration ( r=0.506, P=0.007). Compared with healthy controls, the perAF of nonresponse group showed increased in the left ACC, which was negatively correlated with frequency ( r=-0.414, P=0.032). Conclusion:The neural activity of prefrontal cortex and ACC may be the neuropathological basis underlying response to NSAIDs in MwoA treatment.Moreover, the ACC has certain correlations with migraine-related characteristics, which may serve as a potential neuroimaging biomarker to evaluate the efficacy of NSAIDs.
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Objective:To investigate the efficacy and safety of transcranial alternating current stimulation (tACS) in treating migraine without aura.Methods:A prospective study was performed. From June 2021 to June 2022, 40 migraine without aura patients treated at Vertigo Center, Department of Neurology, Second Affiliated Hospital of Zhengzhou University were enrolled; they were randomly assigned to true group ( n=20) and pseudo group ( n=20); treatment was given for 4 consecutive weeks and follow-up was given for 4 weeks. Pseudo group did not receive current stimulation, while true group received stimulation by 77.5 Hz, 15 mA alternating current through electrodes placed on the forehead and bilateral mastoid (twice/d, 40 min each time, 5 d as a course, a total of 4 courses). Efficacies and adverse reactions were assessed before treatment, and at the end of treatment and follow-up, respectively. Results:Compared with pseudo group, the average monthly migraine days, visual analog scale (VAS) scores, Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Scale (HAMA) scores and Hamilton Depression Scale (HAMD) scores decreased statistically in true group ( P<0.05), and Migraine-specific Quality of Life Questionnaire (MSQ) scores increased statistically in true group ( P<0.05). In true group, compared with those before treatment, the average monthly migraine days, VAS scores, PSQI, HAMA scores and HAMD scores significantly decreased, and MSQ scores increased statistically at the end of treatment and follow-up ( P<0.05). During treatment, no adverse reactions such as seizures, hearing loss, scalp burns, dizziness, or tinnitus were noted in true group and pseudo group. Conclusion:Repeated tACS can obviously reduce frequency and degree of migraine, improve quality of life in migraine without aura patients; and good safety can be recorded.
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OBJECTIVE@#To compare the clinical effect between heat-sensitive moxibustion and mild moxibustion for migraine without aura.@*METHODS@#A total of 54 patients with migraine without aura were randomized into an observation group (27 cases, 2 cases dropped off) and a control group (27 cases, 2 cases dropped off). The basic western medication treatment was adopted in the two groups. In the control group, mild moxibustion was applied at Shuaigu (GB 8), Fengchi (GB 20) and Yanglingquan (GB 34) on the affected side. In the observation group, the frequent acupoint areas of the affected side i.e. Shuaigu (GB 8), Fengchi (GB 20), Taiyang (EX-HN 5), Taichong (LR 3), Yanglingquan (GB 34) were determined, 3 acupoints with strong heat-sensitive sensation were selected each time and mild moxibustion was adopted. The treatment was given once a day, 5 times of treatment was as one course and 2 courses were required in the two groups. Before and after treatment, the scores of migraine symptom, visual analogue scale (VAS), migraine specific quality of life questionnaire (MSQ) were observed, and the clinical efficacy was evaluated after treatment in the two groups.@*RESULTS@#After treatment, the scores of migraine symptom and VAS were decreased compared with those before treatment (P<0.01), while the MSQ scores were increased compared with those before treatment (P<0.01) in the two groups. After treatment, the scores of migraine symptom and VAS in the observation group were lower than those in the control group (P<0.05), while the MSQ score in the observation group was higher than that in the control group (P<0.01). The total effective rate was 92.0% (23/25) in the observation group, which was superior to 72.0% (18/25) in the control group (P<0.05).@*CONCLUSION@#Both heat-sensitive moxibustion and mild moxibustion can effectively alleviate the clinical symptoms, improve the headache degree and life quality in patients with migraine without aura, the clinical efficacy of heat-sensitive moxibustion is superior to that of mild moxibustion.
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Humanos , Moxibustión , Terapia por Acupuntura , Migraña sin Aura/terapia , Calor , Calidad de Vida , Puntos de Acupuntura , Resultado del TratamientoRESUMEN
Abstract Background Migraine affects 1 billion people worldwide and > 30 million Brazilians; besides, it is an underdiagnosed and undertreated disorder. Objective The need to disseminate knowledge about the prophylactic treatment of migraine is known, so the Brazilian Headache Society (SBCe, in the Portuguese acronym) appointed a committee of authors with the objective of establishing a consensus with recommendations on the prophylactic treatment of episodic migraine based on articles from the world literature as well as from personal experience. Methods Meetings were held entirely online, with the participation of 12 groups that reviewed and wrote about the pharmacological categories of drugs and, at the end, met to read and finish the document. The drug classes studied in part II of this Consensus were: antihypertensives, selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, calcium channel blockers, other drugs, and rational polytherapy. Results From this list of drugs, only candesartan has been established as effective in controlling episodic migraine. Flunarizine, venlafaxine, duloxetine, and pizotifen were defined as likely to be effective, while lisinopril, enalapril, escitalopram, fluvoxamine, quetiapine, atorvastatin, simvastatin, cyproheptadine, and melatonin were possibly effective in prophylaxis of the disease. Conclusions Despite an effort by the scientific community to find really effective drugs in the treatment of migraine, given the large number of drugs tested for this purpose, we still have few therapeutic options.
Resumo Antecedentes Migrânea afeta um bilhão de pessoas em todo o mundo e mais de 30 milhões de brasileiros; além disso, é um distúrbio subdiagnosticado e subtratado. Objetivo Sabe-se sobre a necessidade de difundir o conhecimento sobre o tratamento profilático da migrânea; por isso, a Sociedade Brasileira de Cefaleias (SBCe) nomeou um comitê de autores com o objetivo de estabelecer um consenso com recomendações sobre o tratamento profilático da migrânea episódica com base em artigos da literatura mundial, assim como da experiência pessoal. Métodos As reuniões foram realizadas inteiramente online, com a participação de 12 grupos que revisaram e escreveram sobre as categorias farmacológicas dos medicamentos e, ao final, reuniram-se para a leitura e conclusão do documento. As classes de medicamentos estudadas na parte II deste Consenso foram: anti-hipertensivos, inibidores seletivos de recaptação de serotonina, inibidores de recaptação de serotonina e noradrenalina, bloqueadores dos canais de cálcio, outros medicamentos e politerapia racional. Resultados Desta lista de medicamentos, apenas o candesartan foi estabelecido como eficaz no controle da migrânea episódica. Flunarizina, venlafaxina, duloxetina e pizotifeno foram definidos como provavelmente eficazes, enquanto lisinopril, enalapril, escitalopram, fluvoxamina, quetiapina, atorvastatina, sinvastatina, ciproheptadina e melatonina foram possivelmente eficazes na profilaxia da doença. Conclusões Apesar do esforço da comunidade científica em encontrarmedicamentos realmente eficazes no tratamento da migrânea, dado o grande número de medicamentos testados para este fim, ainda dispomos de poucas opções terapêuticas.
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ABSTRACT Obesity and headache disorders are two very common conditions in the general population that have been increasing in incidence over the last decades. Recent studies have shown a significant relationship between obesity and headaches, particularly migraine, with an important role in whether the disease is chronic. On the other hand, no such association was found with tension-type headaches. Studies showing an overlapping of hunger-control pathways and those involved in the pathophysiology of migraine may justify the close association between obesity and migraine. Moreover, a secondary headache for which obesity is a strong risk factor is idiopathic Intracranial Hypertension (pseudotumor cerebri), with several studies showing the impact of weight reduction/bariatric surgery in the treatment of the disease. In conclusion, since obesity is a modifiable risk factor, it is important for physicians treating patients with headaches, and particularly migraine, to be aware of the association between these two disorders.
RESUMO Obesidade e cefaleias são duas condições muito frequentes na população geral e que vem aumentando em incidência nas últimas décadas. Estudos recentes têm demonstrado uma significativa relação entre obesidade e cefaleia, particularmente na enxaqueca, com papel importante na cronificação da doença. Por outro lado, não se observa tal associação com cefaleia do tipo tensão. Trabalhos que mostram uma sobreposição das vias de controle da fome e daquelas envolvidas na fisiopatologia da enxaqueca podem justificar a íntima associação entre obesidade e enxaqueca. Além disso, uma cefaleia secundária para a qual a obesidade é um forte fator de risco é a Hipertensão Intracraniana Idiopática (pseudotumor cerebral), inclusive com diversos estudos mostrando o impacto da redução do peso/cirurgia bariátrica no tratamento da doença. Concluindo, visto que a obesidade é um fator de risco modificável, é importante para os médicos que tratam de pacientes com cefaleia e, particularmente, enxaqueca, estarem cientes da associação entre essas duas comorbidades.
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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.
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Humanos , Resistencia a la Insulina , Serpinas , Trastornos Migrañosos , Quimiocinas , Interleucina-18 , Nicotinamida FosforribosiltransferasaRESUMEN
Objetivo: valorar el uso de terapias alternativas no farmacológicas en migraña y variables relacionadas. La migraña afecta a una de cada diez personas en el mundo, con aumento creciente y mayor prevalencia entre mujeres de zonas urbanas. Aunque los tratamientos habituales son farmacológicos, se ha incrementado el uso de terapias alternativas no farmacológicas en migraña y variables relacionadas. Materiales y métodos: estudio observacional transversal mediante encuesta anónima vía web a 3.342 pacientes de países europeos sobre el uso de terapias alternativas para tratamiento de migraña. Variables de estudio: edad, género, país, tipo de localidad, nivel de estudios, ámbito rural o urbano y respuesta al tratamiento. Resultados: la utilización de terapias alternativas en migraña es un fenómeno creciente, con mayor uso en pacientes entre 41-60 años y estudios superiores. Conclusiones: en migraña se observan diferencias por edad, género, nivel cultural y país de procedencia. El uso de la medicina complementaria como alternativa terapéutica en la migraña es poco habitual y se debería indagar con mayor profundidad estableciendo relaciones que permitan apoyar al paciente afectado y priorizar las de mayor evidencia científica..(Au)
Objective: to evaluate the use of alternative non-pharmacological therapies in migraine and related variables. Migraine affects one in ten people worldwide, with a growing increase and a higher prevalence among women in urban areas. Although the usual treatments are pharmacological, the use of alternative techniques is increasing. Materials and methods: cross-sectional observational study by anonymous web survey of 3,342 patients from European countries on the use of alternative therapies. Study variables: age, gender, country, type of locality, educational level, rural or urban setting and treatment response. Results: the use of alternative therapies in migraine treatment is a growing phenomenon, with greater use in patients between 41-60 years of age and higher education. Conclusions: in Migraine, differences are observed by age, gender, cultural level and country of origin. The use of complementary medicine as an therapeutic alternative in migraine is uncommon and should be investigated in greater depth, establishing relationships that allow supporting the affected patient and prioritizing, if possible, some over others with scientific evidence..(Au)