RESUMO
Despite the prevalence of migraine, the pathophysiology of the disease remains unclear. Current understanding of migraine has alluded to the possibility of a hyperexcitable brain. The aim of the current study is to investigate human brain metabolite differences in the anterior cingulate cortex (ACC) during the interictal phase in migraine patients. We hypothesized that there may be differences in levels of excitatory neurotransmitters and/or their derivatives in the migraine cohort in support of the theory of hyperexcitability in migraine. 2D J-resolved proton magnetic resonance spectroscopy ((1)H-MRS) data were acquired on a 3 Tesla (3 T) MRI from a voxel placed over the ACC of 32 migraine patients (MP; 23 females, 9 males, age 33 ± 9.6 years) and 33 healthy controls (HC; 25 females, 8 males, age 32 ± 9.6 years). Amplitude correlation matrices were constructed for each subject to evaluate metabolite discriminability. ProFit-estimated metabolite peak areas were normalized to a water reference signal to assess subject differences. The initial analysis of variance (ANOVA) was performed to test for group differences for all metabolites/creatine (Cre) ratios between healthy controls and migraineurs but showed no statistically significant differences. In addition, we used a multivariate approach to distinguish migraineurs from healthy subjects based on the metabolite/Cre ratio. A quadratic discriminant analysis (QDA) model was used to identify 3 metabolite ratios sufficient to minimize minimum classification error (MCE). The 3 selected metabolite ratios were aspartate (Asp)/Cre, N-acetyl aspartate (NAA)/Cre, and glutamine (Gln)/Cre. These findings are in support of a 'complex' of metabolite alterations, which may underlie changes in neuronal chemistry in the migraine brain. Furthermore, the parallel changes in the three-metabolite 'complex' may confer more subtle but biological processes that are ongoing. The data also support the current theory that the migraine brain is hyperexcitable even in the interictal state.
Assuntos
Ácido Aspártico/análogos & derivados , Ácido Glutâmico/metabolismo , Glutamina/metabolismo , Giro do Cíngulo/metabolismo , Transtornos de Enxaqueca/patologia , Adolescente , Adulto , Análise de Variância , Ácido Aspártico/metabolismo , Estudos de Coortes , Feminino , Giro do Cíngulo/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico por imagem , Espectroscopia de Prótons por Ressonância Magnética , Adulto JovemRESUMO
The objective of this study was to identify prognostic factors and assess functional status over time among patients in a headache specialty practice. Study questionnaires were mailed to 599 patients who previously presented to a headache specialty practice. Outcome measures included headache frequency, the Headache Impact Test (HIT) and the SF-36 Health Survey. Completed surveys were received from 333 respondents (56%). Thirty-five respondents (11%) had HIT scores in the 'little or no impact' range at follow-up and 191 (57%) had HIT scores in the 'severe impact' range. A diagnosis of migraine at baseline was an independent predictor of elevated HIT scores at follow-up, but gender, age, age at headache onset, daily headache at baseline, and time to follow-up did not predict poor prognosis. A subset of headache patients continue to experience marked disability and impaired functional status, months to years after presenting for headache specialty care. A diagnosis of migraine at the time of presentation may predict prognosis, but additional cohort studies with careful attention to baseline variables are needed to help identify other prognostic factors.
Assuntos
Atividades Cotidianas , Avaliação da Deficiência , Medicina , Transtornos de Enxaqueca/fisiopatologia , Especialização , Adulto , Feminino , Seguimentos , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/epidemiologia , Neurologia , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
We describe a man with chronic paroxysmal hemicrania, who remained free of headaches on indomethacin, 25 mg once or twice daily. However, in this case, in contrast to typical cases of paroxysmal hemicrania, the pain of the headaches was nonlateralized and was located in the centre of the forehead. The headaches were not associated with local autonomic symptoms or signs involving the eyes or nose. Initially, the pain of the headaches lasted for seconds only and was brought on by coughing.
Assuntos
Dor/diagnóstico , Dor/etiologia , Cefaleias Vasculares/complicações , Cefaleias Vasculares/diagnóstico , Adulto , Fármacos Cardiovasculares/uso terapêutico , Cefaleia Histamínica/complicações , Cefaleia Histamínica/diagnóstico , Diagnóstico Diferencial , Humanos , Indometacina/uso terapêutico , Masculino , Dor/classificação , Dor/tratamento farmacológico , Resultado do Tratamento , Cefaleias Vasculares/classificação , Cefaleias Vasculares/tratamento farmacológicoRESUMO
We describe the preventive use of naratriptan, mostly as add-on to high-dose verapamil treatment, in nine patients with cluster headache. The addition of the naratriptan further improved the headaches in seven of the nine patients.
Assuntos
Cefaleia Histamínica/prevenção & controle , Indóis/uso terapêutico , Piperidinas/uso terapêutico , Adulto , Idoso , Cefaleia Histamínica/fisiopatologia , Feminino , Humanos , Indóis/efeitos adversos , Masculino , Pessoa de Meia-Idade , Piperidinas/efeitos adversos , TriptaminasRESUMO
Two patients with migraine are described who also suffered from gastric reflux. The reflux triggered headaches that originated from the upper gum/teeth and responded to specific reflux treatment.
Assuntos
Refluxo Gastroesofágico/complicações , Gengiva/fisiopatologia , Transtornos de Enxaqueca/etiologia , Dente/fisiopatologia , Adulto , Feminino , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/fisiopatologiaRESUMO
Three patients are described who experienced headache from hypertension: one had acute headache from acute hypertension, one had daily, morning headaches from chronic hypertension, and one had acute headache with generalized tonic-clonic seizure from hypertensive encephalopathy. The presumed pathophysiological mechanisms involved in the three hypertensive headache conditions are reviewed.