Article

Headache: the changing migraine brain.

Department of Neurology, Chair Leiden Centre for Translational Neuroscience, Leiden University Medical Center, 2300 RC Leiden, Netherlands. Electronic address: .
The Lancet Neurology (Impact Factor: 21.82). 01/2013; 12(1):6-8. DOI: 10.1016/S1474-4422(12)70290-9
Source: PubMed
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    ABSTRACT: To assess the longitudinal gray matter (GM) and white matter (WM) changes between repeated observations 1 year apart in a group of the early clinical stage of migraine patients without aura, and to explore the relationship of such structural changes with headache activity, we studied patients newly diagnosed with episodic migraine lasting 8 to 14 weeks. Optimized voxel-based morphometry and tract-based spatial statistical analyses were used to evaluate changes in GM and WM by using 3-dimensional T1-weighted and diffusion-tensor imaging, respectively. At the 1-year follow-up examination, GM reduction was observed in the dorsolateral and medial part of the superior frontal gyrus, orbitofrontal cortex, hippocampus, precuneus, and primary and secondary somatosensory cortices. No significant differences were found in the fractional anisotropy and longitudinal, radial, and mean diffusivity of WM in migraine patients without aura within a year. Negative results were found for the association between changes in headache activity parameters and GM. Our results indicated that the GM and WM changed in different pathophysiological conditions of migraine patients without aura. The WM probably evolves slowly in the course of migraine chronicity. Our study found early involvement of GM reduction of sensory-discriminative brain regions in the pathologic process of migraine, but the WM did not exhibit significant changes in the same time interval. GM reduction in sensory-discriminative brain regions may characterize the pathophysiological features of migraine patients without aura in its early stage.
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    ABSTRACT: Migraine is a common disorder and a frequent cause of medical consultation in children. Many childhood episodic syndromes have been described as common precursors of migraine. To review current knowledge on migraine and childhood episodic syndromes, and to discuss future directions for research and clinical practice. For most children it is difficult to describe a headache and fully verbalize symptoms such as photophobia and phonophobia that must be inferred from behaviour. Classical migraine features are rare before the age of 6 years, but some migraine-related syndromes have been described. Benign paroxysmal torticollis of infancy, benign paroxysmal vertigo of childhood, cyclic vomiting syndrome and abdominal migraine are currently classified as childhood episodic syndromes, and therefore common precursors of migraine. A strong association between infantile colic and migraine has recently been reported. There are similarities between children with episodic syndromes and children with migraine, regarding social and demographic factors, precipitating and relieving factors, and accompanying gastrointestinal, neurologic, and vasomotor features. The real pathophysiological mechanisms of migraine are not fully understood. Current data obtained through molecular and functional studies provide a complex model in which vascular and neurologic events cooperate in the pathogenesis of migraine attacks. Genetic factors causing disturbances in neuronal ion channels, make a migraineur more sensitive to multiple trigger factors that activate the nociception cascade. The expanding knowledge on migraine genetics and pathophysiology may be applicable to childhood episodic syndromes. Migraine preventive strategies are particularly important in children, and could be beneficial in childhood episodic syndromes. Nonspecific analgesics like ibuprofen and acetaminophen are widely used in pediatrics to control pain and have been found to be effective also in the treatment of acute migraine attacks. Triptans are the specific fist-line drugs for acute migraine treatment. Migraine phenotype differs somewhat in the developing brain, and childhood episodic syndromes may arise before typical migraine headache. Diagnosing pediatric migraine may be difficult because of children's language and cognitive abilities. The risk of underestimating migraine in pediatric age is high. An adequate diagnosis is important to maintain a good quality of life and to avoid inappropriate therapy.
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    ABSTRACT: Background There is controversy about the efficacy of currently used treatment modalities to alleviate migraine headaches. Objective We aimed to evaluate and compare the effects of magnesium sulfate and combined use of dexamethasone/metoclopramide on relieving acute migraine headache. Methods We randomly divided 70 patients who had been referred to an emergency department, into two equal treatment groups with the two treatment plans, and analyzed pain severity at baseline using a numeric rating scale (NRS). We gave dexamethasone/metoclopramide to one group and magnesium sulfate to the other group, and evaluated pain severity at 20 min and at 1- and 2-h intervals after infusion. Finally, we used repeated-measure and two-way analysis of variance for intra- and inter-group evaluations of pain severity and complications, respectively. Results We found no significant differences in demographic data and pain severity at baseline (8.2 vs. 8.0) between the two groups (p < 0.05). In the dexamethasone/metoclopramide group, pain severity (mean ± standard deviation) was 7.4 ± 1.4 (p = 0.36), 6.0 ± 2.4, and 2.5 ± 2.9 (p < 0.0001) at 20-min, 1-h, and 2-h intervals after treatment, respectively, with statistically significant differences between the baseline values and 1-h and 2-h interval values. Administration of magnesium sulfate was associated with decreased pain severity at the three intervals (5.2 ± 1.7, 2.3 ± 1.9, and 1.3 ± 0.66, respectively), exhibiting significant differences compared to baseline values and the corresponding time intervals in the dexamethasone/metoclopramide group (p < 0.0001). Conclusions According to the results, magnesium sulfate was a more effective and fast-acting medication compared to a combination of dexamethasone/metoclopramide for the treatment of acute migraine headaches.
    Journal of Emergency Medicine 09/2014; · 1.18 Impact Factor