Is blood homocysteine elevated in migraine?

OBJECTIVE: To determine total serum homocysteine levels in a large group of patients with migraine with and without aura. BACKGROUND: Hypercoagulable state is a known risk factor for stroke in the young. The existence of a hypercoagulable state has been postulated in migraine and homocysteinemia with young-onset stroke. To the best of our knowledge, blood homocysteine has not been studied in a significant number of patients with various forms of migraine. METHODS: Total serum homocysteine was measured with high-performance liquid chromatography in 78 patients with migraine and in 126 age- and sex-matched healthy volunteers. RESULTS: Seventy-eight patients aged 18 to 65 years were studied: 22 with migraine with aura and 56 with migraine without aura. Only 1 man had significantly elevated blood homocysteine (38.6 micromol/L), while another had a borderline elevation (15.8 micromol/L) (reference value for both sexes in our laboratory is 4 to 14 micromol/L). Both patients suffered from migraine without aura. CONCLUSIONS: Blood homocysteine is not elevated in migraine.

Effect of withdrawal of misused medication on sleep disturbances in migraine sufferers with chronic daily headache.

OBJECTIVES: To evaluate the sleep pattern of migraineurs with chronic daily headache and to determine whether and to what degree it is improved by withdrawal of medication, and to reconfirm relief of headache by withdrawal of medications in migraineurs with chronic daily headache due to medication misuse. BACKGROUND: Misuse of ergotamine and analgesics by migraineurs is one of the causes of chronic daily headache. The latter is alleviated or abolished in these patients by abrupt withdrawal of the misused medication. In common with patients with chronic daily headache, migraineurs frequently complain of insomnia, usually verifiable by polysomnography. METHODS: Twenty-six women with migraine, aged 18 to 49 years, with chronic daily headache due to medication misuse, voluntarily discontinued ergotamine and analgesics, and were followed at monthly intervals for 3 months. In 25 subjects, polysomnography was performed before withdrawal of medication and 3 months after withdrawal. All subjects filled out a standard sleep questionnaire on those two occasions and a daily self-assessment questionnaire focused on headaches. RESULTS: After 3 months, a significant decrease in mean headache frequency (P<.001) and intensity (P<.001) was demonstrated. Polysomnography performed 3 months after medication withdrawal showed significant improvement in total sleep time (P<.05), sleep efficiency (P<.05), and number of arousals (P<.001). The score of the sleep questionnaire was also significantly improved (P<.01). CONCLUSIONS: In migraineurs with chronic daily headache due to medication misuse, withdrawal of the misused medications alleviates the associated sleep disturbance along with diminution in frequency and intensity of chronic daily headache.