Article

Alcoholic beverages as trigger factor and the effect on alcohol consumption behavior in patients with migraine

Wiley
European Journal of Neurology
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Abstract

Background and purpose Alcoholic beverages are frequently reported migraine triggers. We aimed to assess self‐reported alcohol consumption as a migraine attack trigger and to investigate the effect on alcohol consumption behavior in a large migraine cohort. Methods We conducted a cross‐sectional, web‐based, questionnaire study among 2197 patients with migraine from the well‐defined Leiden University MIgraine Neuro‐Analysis (LUMINA) study population. We assessed alcoholic beverage consumption and self‐reported trigger potential, reasons behind alcohol abstinence and time between alcohol consumption and migraine attack onset. Results Alcoholic beverages were reported as a trigger by 35.6% of participants with migraine. In addition, over 25% of patients with migraine who had stopped consuming or never consumed alcoholic beverages did so because of presumed trigger effects. Wine, especially red wine (77.8% of participants), was recognized as the most common trigger among the alcoholic beverages. However, red wine consistently led to an attack in only 8.8% of participants. Time of onset was rapid (<3 h) in one‐third of patients and almost 90% had an onset <10 h independent of beverage type. Conclusions Alcoholic beverages, especially red wine, are recognized as a migraine trigger factor by patients with migraine and have a substantial effect on alcohol consumption behavior. Rapid onset of provoked migraine attacks in contrast to what is known about hangover headache might point to a different mechanism. The low consistency of provocation suggests that alcoholic beverages acting as a singular trigger is insufficient and may depend on a fluctuating trigger threshold.

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... Rapid onset (within <3 h) of migraine was observed in one-third of these patients. Additionally, patients a ributing migraine to alcohol triggers tended to have a lower BMI, were more frequently diagnosed with MO, experienced a higher annual migraine a ack frequency and more migraine days, consumed slightly more alcohol per occasion, and exhibited a preference for vodka over red wine [29]. In a cross-sectional survey in the United States, female migraine patients were found to have a higher likelihood of being alcohol consumers compared to non-migraine females (OR: 1.5; 95% CI: 1.3 to 1.8; p < 0.0001) [9]. ...
... In a 2011 questionnaire-based study in Denmark, among patients reporting alcohol as a trigger, the proportion for red wine (91%) exceeded that for liquor (50%), champagne or sparkling wine (41%), white wine (23%), and beer (18%) [18]. Similar findings were reported in a cross-sectional study in the Netherlands, identifying red wine as the most common migraine trigger among alcoholic beverages (77.8%) [29]. In the Dutch study, the prevalence of red wine as a trigger even surpassed that of vodka and whiskey. ...
... Furthermore, only 46.5% reported an a ack provocation occurring on more than 50% of occasions after red wine consumption. Over 25% of migraine patients who abstained from or never consumed alcoholic beverages did so due to presumed trigger effects [29]._ENREF_5 However, a study in Austria found that only 2.1% of patients mentioned red wine as a trigger [34]. ...
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Migraine is a prevalent neurological disorder characterized by significant disability and triggered by various factors, including dietary habits. This review explores the complex relationship between diet and migraine, highlighting both triggering and protective roles of dietary patterns and specific nutrients. Evidence suggests that certain foods, such as alcohol, caffeine, chocolate, MSG, nitrates, and tyramine, can trigger migraines in susceptible individuals. Conversely, dietary interventions, including carbohydrate-restricted diets, ketogenic diets, vitamin D3 supplementation, omega-3 fatty acids, Mediterranean dietary patterns, and increased water intake, have shown potential in reducing migraine frequency and severity. Observational studies also indicate that maintaining a healthy diet, rich in fruits and vegetables and low in processed foods, is associated with better migraine outcomes. The effectiveness of these interventions varies among individuals, underscoring the importance of personalized approaches. Future studies should further explore the role of diet in migraine management, focusing on randomized trials to establish causality and refine dietary recommendations for patients.
... Migraine triggers are factors alleged to initiate a sequence of events that culminate in the attack. Stress, sleep deprivation, fatigue, bright lights, odors, menses, noise, skipping meals, weather changes, certain foods and alcohol are among the most reported triggers in clinical studies (Table 2) (17,21,27,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47). Triggers are important for patients because they want to avoid attacks and therefore they modify behaviors that may facilitate them. ...
... Alcohol is frequently reported as a migraine trigger and is one of the most reported external triggers (6,27,33,38,(40)(41)(42)128). Red wine is the most reported trigger among alcoholic beverages, although it consistently led to an attack in only a minority of patients (42). ...
... Alcohol is frequently reported as a migraine trigger and is one of the most reported external triggers (6,27,33,38,(40)(41)(42)128). Red wine is the most reported trigger among alcoholic beverages, although it consistently led to an attack in only a minority of patients (42). This suggests that the ability of alcohol to trigger headache may depend on fluctuating trigger threshold (42). ...
Article
Background The prodrome or premonitory phase is the initial phase of a migraine attack, and it is considered as a symptomatic phase in which prodromal symptoms may occur. There is evidence that attacks start 24–48 hours before the headache phase. Individuals with migraine also report several potential triggers for their attacks, which may be mistaken for premonitory symptoms and hinder migraine research. Methods This review aims to summarize published studies that describe contributions to understanding the fine difference between prodromal/premonitory symptoms and triggers, give insights for research, and propose a way forward to study these phenomena. We finally aim to formulate a theory to unify migraine triggers and prodromal symptoms. For this purpose, a comprehensive narrative review of the published literature on clinical, neurophysiological and imaging evidence on migraine prodromal symptoms and triggers was conducted using the PubMed database. Results Brain activity and network connectivity changes occur during the prodromal phase. These changes give rise to prodromal/premonitory symptoms in some individuals, which may be falsely interpreted as triggers at the same time as representing the early manifestation of the beginning of the attack. By contrast, certain migraine triggers, such as stress, hormone changes or sleep deprivation, acting as a catalyst in reducing the migraine threshold, might facilitate these changes and increase the chances of a migraine attack. Migraine triggers and prodromal/premonitory symptoms can be confused and have an intertwined relationship with the hypothalamus as the central hub for integrating external and internal body signals. Conclusions Differentiating migraine triggers and prodromal symptoms is crucial for shedding light on migraine pathophysiology and improve migraine management.
... Individual dietary factors (e.g., foods, beverages, and habits) trigger the onset and increased severity of migraine via proposed vascular, neuropeptide, neuroinflammation, insulin, and oxidant-antioxidant pathways [122][123][124]. Common triggers include chocolate, nuts, citrus, cheese, and other dairy products [125][126][127]. Alcohol has also been identified as a common dietary factor associated with migraine, with 17.5% to 35.6% of individuals reporting the beverage as a potential trigger [125][126][127]. ...
... Common triggers include chocolate, nuts, citrus, cheese, and other dairy products [125][126][127]. Alcohol has also been identified as a common dietary factor associated with migraine, with 17.5% to 35.6% of individuals reporting the beverage as a potential trigger [125][126][127]. When compared to other types of alcoholic beverages, red wine is the most commonly reported trigger by individuals suffering from migraine [127]. ...
... Alcohol has also been identified as a common dietary factor associated with migraine, with 17.5% to 35.6% of individuals reporting the beverage as a potential trigger [125][126][127]. When compared to other types of alcoholic beverages, red wine is the most commonly reported trigger by individuals suffering from migraine [127]. Caffeinated beverages, such as coffee, energy drinks, teas, and sodas, are also potential triggers, yet findings are inconsistent. ...
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This review summarizes the relationship between diet, the gut microbiome, and migraine. Key findings reveal that certain dietary factors, such as caffeine and alcohol, can trigger migraine, while nutrients like magnesium and riboflavin may help alleviate migraine symptoms. The gut microbiome, through its influence on neuroinflammation (e.g., vagus nerve and cytokines), gut–brain signaling (e.g., gamma-aminobutyric acid), and metabolic function (e.g., short-chain fatty acids), plays a crucial role in migraine susceptibility. Migraine can also alter eating behaviors, leading to poor nutritional choices and further exacerbating the condition. Individual variability in diet and microbiome composition highlights the need for personalized dietary and prebiotic interventions. Epidemiological and clinical data support the effectiveness of tailored nutritional approaches, such as elimination diets and the inclusion of beneficial nutrients, in managing migraine. More work is needed to confirm the role of prebiotics, probiotics, and potentially fecal microbiome translation in the management of migraine. Future research should focus on large-scale studies to elucidate the underlying mechanisms of bidirectional interaction between diet and migraine and develop evidence-based clinical guidelines. Integrating dietary management, gut health optimization, and lifestyle modifications can potentially offer a holistic approach to reducing migraine frequency and severity, ultimately improving patient outcomes and quality of life.
... Whether an AIH effect manifests immediately or is delayed depends on groups, regions, and the specific alcoholic beverages consumed. Different alcoholic beverage types are the prominent AIH factor documented in several pieces of literature [1,[4][5][6]. ...
... A study reported that congener-induced AIHs differ significantly amongst beverage types: bourbon, whiskey, and vodka [7]. Furthermore, high amounts of congeners such as flavonoids and biogenic amine in red wine trigger migraines [5]. Alcoholic beverages with high congener contents, such as bourbon, have been reported to elicit more severe AIH conditions than beverages with lower congener content [8,9]. ...
... Histamine is an important congener component of alcoholic beverages. Although many small-scale clinical experiments have tested its effects on AIHs [124][125][126], AIH responses have not been consistent [5,95]. Evidence suggests that histamine may influence AIHs through a significant relationship with TRPV1 and TLR4, and this is a promising direction for future research. ...
Article
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Ethanol and other congeners in alcoholic beverages and foods are known triggers of alcohol-induced headaches (AIHs). Recent studies implicate AIHs as an important underlying factor for neuroinflammation. Studies show the relationship between alcoholic beverages, AIH agents, neuroinflammation, and the pathway they elicit. However, studies elucidating specific AIH agents' pathways are scarce. Works reviewing their pathways can give invaluable insights into specific substances' patterns and how they can be controlled. Hence, we reviewed the current understanding of how AIH agents in alcoholic beverages affect neuroinflammation and their specific roles. Ethanol upregulates transient receptor potential cation channel subfamily V member 1 (TRPV1) and Toll-like receptor 4 (TLR4) expression levels; both receptors trigger a neuroinflammation response that promotes AIH manifestation-the most common cause of AIHs. Other congeners such as histamine, 5-HT, and condensed tannins also upregulate TRPV1 and TLR4, neuroinflammatory conditions, and AIHs. Data elucidating AIH agents, associating pathways, and fermentation parameters can help reduce or eliminate AIH inducers and create healthier beverages.
... Alcohol use was found to be associated with migraine in 17.5%, 20.5% and 35.6% participants in 3 questionnaire studies. [33][34][35] One study reported red wine (77.8%) as the most common trigger among alcoholic beverages. 33 Alcohol was found to be associated with migraine in a Chinese cross-sectional study. ...
... [33][34][35] One study reported red wine (77.8%) as the most common trigger among alcoholic beverages. 33 Alcohol was found to be associated with migraine in a Chinese cross-sectional study. 36 However, the association was less likely to be present in women compared to men. ...
... 32 In another Korean prospective, observational study, overeating was significantly associated with migraine compared to nonmigraine headaches (OR = 2.4; 95% CI = 1.1, 5.7; P = .001). 14 A Turkish prospective cohort study 32 Prospective cohort study, N = 126 Triggers for migraine included alcohol Onderwater, 2019 33 Cross-sectional, questionnaire study, N = 2197 ...
Article
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Background: Migraine is a disabling primary headache disorder often associated with triggers. Diet-related triggers are a common cause of migraine and certain diets have been reported to decrease the frequency of migraine attacks if dietary triggers or patterns are adjusted. Objective: The systematic literature review was conducted to qualitatively summarize evidence from the published literature regarding the role of diet patterns, diet-related triggers, and diet interventions in people with migraine. Methods: A literature search was carried out on diet patterns, diet-related triggers, and diet interventions used to treat and/or prevent migraine attacks, using an a priori protocol. MEDLINE and EMBASE databases were searched to identify studies assessing the effect of diet, food, and nutrition in people with migraine aged ≥18 years. Only primary literature sources (randomized controlled trials or observational studies) were included and searches were conducted from January 2000 to March 2019. The NICE checklist was used to assess the quality of the included studies of randomized controlled trials and the Downs and Black checklist was used for the assessment of observational studies. Results: A total of 43 studies were included in this review, of which 11 assessed diet patterns, 12 assessed diet interventions, and 20 assessed diet-related triggers. The overall quality of evidence was low, as most of the (68%) studies assessing diet patterns and diet-related triggers were cross-sectional studies or patient surveys. The studies regarding diet interventions assessed a variety of diets, such as ketogenic diet, elimination diets, and low-fat diets. Alcohol and caffeine uses were the most common diet patterns and diet-related triggers associated with increased frequency of migraine attacks. Most of the diet interventions, such as low-fat and elimination diets, were related to a decrease in the frequency of migraine attacks. Conclusions: There is limited high-quality randomized controlled trial data on diet patterns or diet-related triggers. A few small randomized controlled trials have assessed diet interventions in preventing migraine attacks without strong results. Although many patients already reported avoiding personal diet-related triggers in their migraine management, high-quality research is needed to confirm the effect of diet in people with migraine.
... We read with interest the paper by Onderwater et al. [1] that reported on alcoholic beverages as a trigger factor for migraines. Although epidemiological studies have found a correlation between alcohol intake and headaches, a specific pathophysiological mechanism of this headache remains unidentified [2]. ...
... Although epidemiological studies have found a correlation between alcohol intake and headaches, a specific pathophysiological mechanism of this headache remains unidentified [2]. In particular, red wine was documented as the most common trigger for migraines in this evaluated population [1]. Most commonly found biogenic amines in winehistamine, tyramine, phenylethylamine, putrescine, cadaverine, spermidine, sero-tonin, tryptamine, agmatineand flavonoids have suspected relevance for migraines, and this implies that ethanol seems not to be the main culprit for the headaches [2]. ...
... Vodka is a clear, distilled alcoholic beverage, made by distilling fermented potatoes or grains that originally have low histamine content [4]. The consumption of vodka was also shown to induce fewer migraines than red wine [1]. ...
Article
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We read with interest the manuscript by Onderwater et al. that reported on alcoholic beverages as a trigger factor for migraines [1]. Although, epidemiological studies have found a correlation between alcohol intake and headaches, a specific pathophysiologic mechanism of this headache remains unidentified [2]. Particularly red wine was documented as the most common trigger for migraines in this evaluated population [1]. Most commonly found biogenic amines in wine ‐ histamine, tyramine, phenylethylamine, putrescine, cadaverine, spermidine, serotonin, tryptamine, agmatine ‐ and, flavonoids have suspected relevance for migraines and this implies that ethanol seems not to be the main culprit for the headaches [2].
... Our participants' consumption of beer and red wine was zero, which contradicts Onderwater et al. 39 . According to Zaeem et al. 40 , alcohol contains high levels of histamine and it inhibits the enzyme that metabolizes histamine; accumulation of histamine in the blood triggers migraines, but our results may have shown the opposite due to religious considerations of the study community. ...
Article
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Despite the high prevalence of primary headaches, the role of food in modifying clinical characteristics among migraine patients is often overlooked. The aim is to detect the correlation between adopting unhealthy dietary habits and migraine severity and identify foods that have a greater chance of triggering specific subtypes of migraine. The present study was a cross-sectional analytical study that was conducted at Kasralainy Hospital, Cairo University, headache clinic at Alexandria University Hospital, and Al-Azhar University Hospitals from January to June 2020. We included 124 patients fulfilling the ICHD-3 criteria for migraine. A full clinical profile for migraine headaches was reported using a headache sheet applied to the Al-Azhar University headache unit. A nutritionist obtained data collected about dietary habits using many reliable scales and questionnaires such as food frequently sheets questionnaire. Logistic regression and Pearson correlation coefficients have been used to identify foods that are more likely to be associated with increased clinical features of migraine. Our participants reported that the fried meat, fried chicken, processed meats, fava beans, falafel, aged cheese “Pottery salted cheese” and “Rummy cheese”, salted-full fatty cheese “Damietta cheese”, citrus fruits, tea, coffee, soft drinks, nuts, pickles, chocolate, canned foods, sauces, ice cream, smoked herring, in addition to the stored food in the refrigerator for many days were significantly associated with the diagnosis of chronic migraine (CM) compared to episodic migraine (EM). Margarine, pickles, and smoked herring were significantly associated with the diagnosis of migraine with aura (MA) compared to migraine without aura (MO). Adopting unhealthy eating habits was a more prevalent dietary consumption pattern among people with chronic migraines compared to those with episodic migraine.
... 3 The reasons for potentially decreased alcohol consumption stem from widely held beliefs that alcohol can trigger or exacerbate migraine, with one study reporting that 35.6% of its 2197 participants noted alcoholic beverages to be a "trigger" of migraine, with red wine being most commonly implicated. 4 A 2022 prospective study conversely suggested that there was no significant effect on the likelihood of a migraine attack in the 24 hours after drinking, and a slightly lower chance from 24 to 48 hours after ingestion. 5 A 2020 prospective study showed that in adults with episodic migraine, ingestion of five or more drinks was associated with a twofold increase in headache the next day but there was no increase with one to two drinks. ...
Article
Objective The relationship between migraine and alcohol consumption is unclear. We assessed the association between chronic migraine and alcohol use disorder(AUD), relative to chronic disease controls, and in conjunction with common comorbidities. Methods We conducted a retrospective, observational study. The primary outcome was the odds ratio for AUD in patients with chronic migraine or with chronic migraine and additional comorbidities relative to controls. Results A total of 3701 patients with chronic migraine, 4450 patients with low back pain, and 1780 patients with type 2 diabetes mellitus met inclusion criteria. Patients with chronic migraine had a lower risk of AUD relative to both controls of low back pain ( OR 0.37; 95% CI: 0.29–0.47, p < 0.001) and type 2 diabetes mellitus ( OR 0.39; 95% CI: 0.29–0.52, p < 0.001). Depression was associated with the largest OR for AUD in chronic migraine ( OR 8.62; 95% CI: 4.99–14.88, p < 0.001), followed by post-traumatic stress disorder ( OR 6.63; 95% CI: 4.13–10.64, p < 0.001) and anxiety ( OR 3.58; 95% CI: 2.23–5.75, p < 0.001). Conclusion Patients with chronic migraine had a lower odds ratio of AUD relative to controls. But in patients with chronic migraine, those with comorbid depression, anxiety, or PTSD are at higher risk of AUD. When patients establish care, comorbid factors should be assessed and for those at higher risk, AUD should be screened for at every visit.
... The consumption of alcoholic beverages is commonly noted as a migraine trigger. Alcoholic beverages were found to be a trigger by 35.6% of migraine patients in a cross-sectional, web-based questionnaire survey [8]. Another prospective cross-sectional research showed that widely consumed dietary triggers were coffee (19.9%), chocolate (7.5%), and food rich in monosodium glutamate (5.6%) [9]. ...
Article
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Introduction Migraine is a neurological condition that frequently results in a severe headache. The headache comes in episodes and is occasionally accompanied by nausea, vomiting, and sensitivity to light. Migraines can be caused by a variety of conditions and can last anywhere from three to four hours to several days, with females experiencing them three times more frequently than men. Studies have found some evidence that lifestyle variables, such as nutrition, may play an important role in the emergence of migraines. The purpose of this research is to determine the epidemiology of migraine among females with an emphasis on the relationship between headaches and the dietary habits of females who are enduring migraine attacks in Iraq. Methods This study is descriptive research employing a quantitative method, specifically a survey. The data collection process involved a three-section online survey disseminated to females through internet platforms, including WhatsApp, Viber, Facebook, and Instagram. In this research, 360 females from Sulaymaniyah, Iraq, aged 18 to 35, participated. The survey's primary questions centered on the characteristics of the female respondents, drawing from the International Headache Society (IHS) criteria for migraine diagnosis. Participants meeting the migraine diagnostic criteria were also asked a few questions about aura symptoms. The Migraine Disability Assessment (MIDAS) questionnaire was incorporated, accompanied by inquiries about headache treatment, headache-related signs and symptoms, headache triggers, factors that relieve headaches, sleep routines, dietary consumption, and the impact of each factor on migraines. Results Of the 360 females who participated in the study, 159 (44.2%) experienced migraines, while 201 (55.8%) did not. The dietary habits of females who experienced migraines showed a statistically significant relationship to the duration of their headaches, specifically those lasting from 4 to 72 hours. This relationship was particularly evident in relation to nuts (p-value= 0.000), hot/spicy foods (p-value= 0.000), tomatoes (p-value= 0.005), bananas (p-value=0.01), aspartame (p-value=0.012), beverages containing caffeine (p-value=0.000), and citrusy fruits (p-value=0.008). These findings are based on p-values less than the commonly accepted alpha of 0.05. To maintain good health, it's essential to adhere to healthy eating habits and proper nutritional guidelines. Further research is necessary to identify additional dietary triggers for migraines. Enhancing data collection methods, such as using face-to-face interviews, could improve the quality of future research. Conclusion This study determined the prevalence of migraines among a sample of females in Sulaymaniyah, Iraq, and identified various foods consumed in excess by females without considering their potential impact on migraines.
... As indicated by Yuan et al. (9), the negative association between genetically predicted alcohol intake and migraine may be due to the stress relieving effect of alcohol as well as the fact that drinkers tend to have a higher tolerance to headache and metabolize alcohol quickly, which makes them less likely to be affected by toxic intermediates that can lead to migraines, such as acetaldehyde (9,55). In addition, we also cannot rule out the possibility that the protective effect of alcohol consumption on migraine is attributable to reverse causality (9), since alcohol, especially red wine (72), was commonly reported as diet-related trigger of migraine attacks (7), patients with migraine are often limited their alcohol intake (46). Several possible underlying mechanisms underlying the inverse association of coffee intake with the risk of migraine may involve the antagonism of caffeine on the adenosine receptors, this can cause the inhibition of receptors, which may contribute to migraine pathophysiology (73). ...
Article
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Objective The important contribution of dietary triggers to migraine pathogenesis has been recognized. However, the potential causal roles of many dietary habits on the risk of migraine in the whole population are still under debate. The objective of this study was to determine the potential causal association between dietary habits and the risk of migraine (and its subtypes) development, as well as the possible mediator roles of migraine risk factors. Methods Based on summary statistics from large-scale genome-wide association studies, we conducted two-sample Mendelian randomization (MR) and bidirectional MR to investigate the potential causal associations between 83 dietary habits and migraine and its subtypes, and network MR was performed to explore the possible mediator roles of 8 migraine risk factors. Results After correcting for multiple testing, we found evidence for associations of genetically predicted coffee, cheese, oily fish, alcohol (red wine), raw vegetables, muesli, and wholemeal/wholegrain bread intake with decreased risk of migraine, those odds ratios ranged from 0.78 (95% CI: 0.63–0.95) for overall cheese intake to 0.61 (95% CI: 0.47–0.80) for drinks usually with meals among current drinkers (yes + it varies vs. no); while white bread, cornflakes/frosties, and poultry intake were positively associated with the risk of migraine. Additionally, genetic liability to white bread, wholemeal/wholegrain bread, muesli, alcohol (red wine), cheese, and oily fish intake were associated with a higher risk of insomnia and (or) major depression disorder (MDD), each of them may act as a mediator in the pathway from several dietary habits to migraine. Finally, we found evidence of a negative association between genetically predicted migraine and drinking types, and positive association between migraine and cups of tea per day. Significance Our study provides evidence about association between dietary habits and the risk of migraine and demonstrates that some associations are partly mediated through one or both insomnia and MDD. These results provide new insights for further nutritional interventions for migraine prevention.
... Recent literature reviews on food triggers for migraines point to alcohol consumption as a common triggering factor for increased frequency of attacks [42,47,48]. Alcoholic beverages, especially red wine, are described as triggers for the onset of migraine attacks [49][50][51][52]. According to the scientifi c literature, the relationship involves the action of biogenic amines, sulfi tes, and phenolic fl avonoids present in such beverages, their vasodilating eff ects, and mechanisms linked to 5-hydroxytryptamine [49,51]. ...
Article
Eating habits and lifestyle were the areas of life most affected by the COVID-19 pandemic, especially in patients with migraine, whose triggers for their crises are related to these factors. Thus, the aim of this study was to systematically review the association between eating habits, lifestyle and migraine attacks during social isolation in the COVID-19 pandemic. Therefore, a systematic review was carried out, developed in accordance with PRISMA and registered in PROSPERO nº CRD42022350308, with observational studies, which evaluated eating habits and lifestyle as exposure variables for the increase or alteration of migraine attacks during the pandemic of COVID-19 in adult patients diagnosed with migraine. Searches were performed in PubMed/MEDLINE, Web of Science, LILACS, and Google Scholar (gray literature) databases, and MESH and DECS database descriptors were used without language limits. 688 publications were identified, of which 11 met the inclusion criteria for data extraction, totaling, in the end, 3,256 respondents. The assessment of the methodological quality of the studies was performed using the Newcastle-Ottawa scale. The publications included were of low to moderate methodological quality, with a high risk of bias, and most found an association between lifestyle, eating habits and migraine attacks. Sleep disorders were most positively associated with migraine attacks, followed by eating habits. However, in most studies, there was no association between caffeine and migraine during the pandemic. We emphasize the need for more prospective, robust studies with better methodological quality to assess the impact of the COVID-19 pandemic on the association between eating habits, lifestyle and migraine attacks.
... Пацієнти з мігренню визначали алкогольні напої, особливо червоне вино, як потенційний тригер мігрені (в групі А p = 0,005, в групі Б p = 0,029) [19]. Алкоголь може індукувати або посилювати окиснювальний стрес [20]. ...
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Актуальність. Мігрень — це генетично обумовлений складний розлад, що характеризується епізодами помірного або сильного головного болю, найчастіше одностороннього та зазвичай пов’язаного з нудотою та підвищеною чутливістю до світла та звуку. Мета роботи: оцінити принцип та режим харчування у пацієнтів з різними формами мігрені залежно від супутніх захворювань шлунково-кишкового тракту; уточнити харчові тригерні фактори, які впливають на головний біль при мігрені; вивчити вплив елімінаційної дієти на частоту та інтенсивність нападів головного болю при мігрені, показники психоемоційного статусу та якість життя. Матеріали та методи. Дослідження включало 112 учасників з хронічною та епізодичною формою мігрені (97 жінок та 15 чоловіків) віком від 20 до 50 років (33,6 ± 5,3). Усі учасники були розподілені на дві групи: А — хворі на хронічну та епізодичну форму мігрені, які дотримувались елімінаційної дієти протягом 3 тижнів, Б — хворі на хронічну та епізодичну форму мігрені, які не дотримувались жодних типів дієт. Результати. При аналізі даних перед початком впровадження елімінаційної дієти виявлено, що середній показник інтенсивності головного болю при мігрені за візуально-аналоговою шкалою (ВАШ) та якості життя за шкалою MIDAS суттєво відрізнялися між двома досліджуваними групами (р < 0,05). У групі А на тлі застосування елімінаційної дієти вірогідно зменшився показник інтенсивності головного болю за ВАШ (р = 0,03), а також вірогідно знизилась частота нападів головного болю (р = 0,003). Водночас у групі В середній рівень частоти та інтенсивності головного болю не зазнав вірогідних змін (р > 0,05). Висновки. Застосування елімінаційної дієти у пацієнтів з мігренню може бути ефективним у запобіганні нападам та зниженні інтенсивності головного болю. Однак навіть елімінаційна дієта має багато недоліків, деякі продукти є складними і містять багато інгредієнтів, отже, складно визначити один конкретний інгредієнт як тригер.
... A number of studies have shown that alcohol is an important headache trigger (5)(6)(7)(8)(9). Some studies have reported that alcohol-induced hangover headaches occur 4-24 hr after the end of alcohol intake and can cause migrainelike symptoms in individuals with a history of migraines, including unilateral throbbing pain and photophobia. ...
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Objectives: The present study aims to establish and evaluate a rat model for hangover headaches caused by alcoholic drinks. Materials and methods: Chronic migraine (CM) model rats were divided into 3 groups, and intragastrically administered alcoholic drinks (sample A, B, or C) to simulate hangover headache attacks. The withdrawal threshold for the hind paw/face and the thermal latency of hind paw withdrawal were detected after 24 hr. Serum was collected from the periorbital venous plexus of rats in each group, and enzymatic immunoassays were used to determine the serum levels of calcitonin gene-related peptide (CGRP), substance P (SP), and nitric oxide (NO). Results: Compared with the control group, the mechanical hind paw pain threshold was significantly lower in rats administered Samples A and B after 24 hr; however, no significant difference was observed across groups for the thermal pain threshold. The mechanical threshold for periorbital pain was only significantly reduced in rats administered Sample A. Immunoassays further indicated that serum levels of SP in the group administered Sample A were significantly higher than those in the control group; the serum levels of NO and CGRP were significantly higher in the group of rats receiving Sample B. Conclusion: We successfully developed an effective and safe rat model for investigating alcohol drink induced hangover headaches. This model could be used to investigate the mechanisms associated with hangover headaches for the development of novel and promising candidates for the future treatment or prophylaxis of hangover headaches.
... The relationship between caffeine and headache is complex. Previous studies have shown that caffeine is an effective adjuvant treatment for acute headache, including migraine [50]. However, additional studies have revealed that overuse of caffeine increases the risk of medication overuse headache and chronic migraine [51,52]. ...
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Purpose of Review We explore recent developments in the prevention and treatment of migraine through dietary interventions. Recent Findings Healthier diets (defined in multiple ways), meal regularity, and weight loss are associated with decreased headache burden. Specific diets including the ketogenic diet, the low-glycemic index diet, and the DASH diet are supported by modest evidence for the prevention of migraine. Neither a gluten-free diet, in patients without celiac disease, nor elimination diets have sufficient evidence for their routine consideration. Summary Diet remains a crucial, but underexplored, component of comprehensive migraine management. Multiple interventions exist for providers and patients to consider integrating into their treatment plan. Larger studies are needed to support stronger recommendations for utilization of specific dietary interventions for the prevention and treatment of migraine.
... A migraine attack may be triggered by factors such as red wine, cheeses, exposure to specific smells (e.g. cigarette smoke) (31) , while TTH may be caused by emotional stress (10) . Alcohol can be a trigger for cluster headache (32) . ...
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It is estimated that 30–80% of the population in Europe and the United States experience frequent and recurrent headaches, the most common of which are tension-type, migraine and cluster headaches. Migraine can also overlap with tension-type headache, which is referred to as vasomotor or mixed headache. According to the 3rd edition of the International Classification of Headache Disorders (ICHD-3 beta), these entities are classified as idiopathic (primary) headaches, where pain is both the essence and the main symptom of the disease. Idiopathic headaches are difficult to diagnose as they differ mainly in intensity. When collecting medical history, the focus should be placed on the duration and location of pain. Therefore, a thorough interview to assess subjective pain intensity is one of the basic elements of the diagnostic workup. Tension-type headache, migraine and cluster headaches are also characterised by specific symptoms, identification of which is essential for the diagnosis. Cluster headache produces the most typical symptoms. Since these types of headaches require different therapeutic strategies, it is necessary to differentiate them. Their treatment requires interdisciplinary cooperation of, among others, dentists, neurologists, and physiotherapists. In this paper, we made an attempt to discuss the pathogenesis, symptoms and differential diagnosis of tension headache, migraine and cluster headache, based on literature review.
... Alcoholic beverages, especially red wine, are recognized by migraine patients as a potential migraine trigger [169]. Alcohol may induce or increase oxidative stress through the generation of ROS and RNS [170]. ...
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The mechanisms of migraine pathogenesis are not completely clear, but 31P-nuclear magnetic resonance studies revealed brain energy deficit in migraineurs. As glycolysis is the main process of energy production in the brain, mitochondria may play an important role in migraine pathogenesis. Nutrition is an important aspect of migraine pathogenesis, as many migraineurs report food-related products as migraine triggers. Apart from approved anti-migraine drugs, many vitamins and supplements are considered in migraine prevention and therapy, but without strong supportive evidence. In this review, we summarize and update information about nutrients that may be important for mitochondrial functions, energy production, oxidative stress, and that are related to migraine. Additionally, we present a brief overview of caffeine and alcohol, as they are often reported to have ambiguous effects in migraineurs. The nutrients that can be considered to supplement the diet to prevent and/or ameliorate migraine are riboflavin, thiamine, magnesium ions, niacin, carnitine, coenzyme Q10, melatonin, lipoic acid, pyridoxine, folate, and cobalamin. They can supplement a normal, healthy diet, which should be adjusted to individual needs determined mainly by the physiological constitution of an organism. The intake of caffeine and alcohol should be fine-tuned to the history of their use, as withdrawal of these agents in regular users may become a migraine trigger.
... Due to religious beliefs, wine consumption is forbidden in the Iranian food culture; hence, the Mediterranean diet scores were calculated in the absence of wine consumption data [27]. Alcoholic beverages were proposed as a trigger factor for a migraine headache in previous studies which this point should be taken into account in future studies during the calculation of the Mediterranean diet score [34]. Moreover, the olive oil consumption was not considered in the calculation of the Mediterranean diet score owing to the low intake of the Iranian population; instead, we used MUFA/SFA ratio in the calculation of the overall score as suggested by Trichopoulou et al. [13,27]. ...
Article
Background The present study was conducted to explore the association between adherence to Mediterranean dietary pattern and migraine headache features including frequency, duration, and severity, as well as patients’ migraine-related disabilities among the Iranian population diagnosed with migraine. Methods In the present cross-sectional study on 262 migraine patients aged 20-50 years old, a validated 168-item, food frequency questionnaire was used to assess the dietary intakes of participants. The Mediterranean diet score was calculated for each subject using nine pre-defined dietary components and ranged from 0-9. The headache severity, duration, frequency, migraine headache index score (MHIS), and headache impact test-6 (HIT-6) were measured using related questionnaires. Results After controlling for potential confounders, Mediterranean diet tended to be associated with lower headache frequency (β = −1.74, 95% CI: −3.53,0.03) and duration (β = −0.28, 95% CI: −0.59, −0.02) and was significantly associated with lower MHIS (β = −29.32, 95% CI: −51.22, −7.42), and HIT-6 score (β = −2.86, 95% CI: −5.40, −0.32) for those in the highest category of Mediterranean diet scores compared to the lowest category. A subgroup analysis of women also revealed a negative association between Mediterranean diet and headaches frequency (β = −2.30, 95% CI: −4.27, −0.32), duration (β = −0.42, 95% CI: −0.78, −0.07), scores of MHIS (β = −47.44, 95% CI: −71.90, −22.99), and HIT-6 (β = −3.45, 95% CI: −6.29, −0.61), after controlling for potential confounders. Conclusions The present study suggests that adherence to the Mediterranean dietary pattern is associated with lower headache frequency, duration, MHIS, and HIT-6 score.
... Biological impact on subjects has raised the desire for a healthier life notwithstanding the threat or fear of health in the future. The research results of Onderwater et al. (2019); Towers et al. (2018) have shown that people consuming alcohol actively will be more susceptible to biological impacts such as internal organs. The internal organs are attacked to reveal the influence between alcoholic drinks with health on alcoholic drink consumers. ...
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Background: The alcoholic drink level of consumption is still high, particularly among adolescents and adults. Continuous consumption of alcoholic drinks can lead to addiction, making it difficult to cope with; however, some individuals with such a situation are could cease the habit. This study aims to explore the process of individuals breaking away from alcohol dependence. Methods: The research approach used qualitative with a phenomenological design. Semi-structured interviews were conducted to obtain in-depth data from eight subjects selected according to purposive sampling criteria. The data was analyzed using a descriptive phenomenological method. Results: The study results found four main themes for quitting alcoholic beverages: the influence of the experience of becoming an addict, a strong internal desire to quit, being threatened by biological impacts, internal and external driving factors to quit. Conclusion: Based on the findings, individuals who want to quit addiction must have a strong desire, consider the biological impact on health and have internal and external driving factors.
... Biological impact on subjects has raised the desire for a healthier life notwithstanding the threat or fear of health in the future. The research results of Onderwater et al. (2019); Towers et al. (2018) have shown that people consuming alcohol actively will be more susceptible to biological impacts such as internal organs. The internal organs are attacked to reveal the influence between alcoholic drinks with health on alcoholic drink consumers. ...
Article
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Background: The alcoholic drink level of consumption is still high, particularly among adolescents and adults. Continuous consumption of alcoholic drinks can lead to addiction, making it difficult to cope with; however, some individuals with such a situation are could cease the habit. This study aims to explore the process of individuals breaking away from alcohol dependence. Methods: The research approach used qualitative with a phenomenological design. Semi-structured interviews were conducted to obtain in-depth data from eight subjects selected according to purposive sampling criteria. The data was analyzed using a descriptive phenomenological method. Results: The study results found four main themes for quitting alcoholic beverages: the influence of the experience of becoming an addict, a strong internal desire to quit, being threatened by biological impacts, internal and external driving factors to quit. Conclusion: Based on the findings, individuals who want to quit addiction must have a strong desire, consider the biological impact on health and have internal and external driving factors.
... In migraine, the ability of external factors to trigger headache attacks is well known. [8][9][10][11] Furthermore, surgeries were developed considering anatomical sites' existence as a possible anatomical triggering of headache attacks. [12][13][14][15] The highest prevalence of ponytail headache may be explained by the theory of peripheral and central sensitization of the nociceptive system of migraineurs. ...
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IntroductionDespite its frequent occurrence, external-traction headache (previously named as “ponytail headache”) is scarcely documented in the literature.Objective In the present study we set out to estimate the prevalence of ponytail headache and its relationship with migraine.Methods One hundred and thirty women (27.7±11.1 years of age), 108 of them reported a previous history of primary headache [81/130 (62.3%) migraine or probable migraine and 27/130 (20.8%) non-migraine headache; 22/130 (16.9%) did not report any previous episode of headache], were requested to wear a ponytail for 60 minutes, removing it only in case of pain. When pain occurred, it was recorded for the latency between the placement of the ponytail and the onset of the pain, its duration and characteristics. The women also filled out a questionnaire on previous headache episodes.ResultsDuring the 60 minute-period, 52/130 (40%) women had ponytail headache elicited by the experiment. There was a higher prevalence of ponytail headache in those who reported previous episodes of primary headache [48/108 (44.4%)], compared to those who did not [4/22 (18.2%)] (p=0.022). The migraineurs had more ponytail headache than non-migraneurs [39/81 (48.2%) versus 9/27 (33.3%), p=0.180] with a positive history of primary headache and they also had more than those without [4/22 (18.2%)] (p=0.012). The group of women with migraine also presented more ponytail-induced headache than non-migraineurs combined with the groupof individuals without a previous history of headache [13/49 (26.5%), OR 2.57, 95%CI 1.19-5.55; p=0.015]. Migraine-like episodes were trigged in 3/52 (5.8%) by the experiment, all three migraineurs. The latency time for the beginning of ponytail headache during the experiment was 21.5 ± 15.4 min and the duration was 76.0±159.3 min.Conclusion The prevalence of ponytail headache in our study was 40% and was statistically higher in migraineurs.
... Alcohol is usually perceived as an important migraine trigger and to become diagnosed with migraine has been associated with reduced or even stopped alcohol consumption. However, its trigger potential tends to be overestimated (Onderwater et al., 2019). Comparison of alcohol consumption to the above quoted German population-based surveys is not possible as alcohol consumption is documented using the Alcohol Use Disorder Identification Test-Consumption (Zeiher et al., 2018), a measure that was not used in our trials. ...
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The objective of this study was to assess the burden of disease and prevalence of lifestyle factors for adolescents and young adults with frequent episodic migraine. We conducted a secondary comparative analysis of data collected during two previous studies. Inclusion criteria for this analysis were age 15–35 years, 15 to 44 migraine episodes within 12 weeks, and completeness of Migraine Disability Assessment and lifestyle questionnaire data. Datasets of 37 adults (median age [interquartile range]: 25 [6]) and 27 adolescents (median age [interquartile range]: 15 [1]) were analyzed. 81% (n = 30) of adults reported severe disability (16% [n = 3] of adolescents; p < 0.001). Headache frequency (24 vs. 17 days; p = 0.005) and prevalence of regular analgesic use (60% [n = 22] vs. 18% [n = 5]; p = 0.002) were significantly higher in adults. In adults, sleep duration on weekdays was significantly lower (8.5 vs. 10 h; p < 0.001). Any consumption of caffeine tended to be higher in adolescents and alcohol consumption tended to be higher in adults (p > 0.05). This study underlines the importance of educating adolescents and young adults with migraine about lifestyle habits that are likely to interfere with the condition.
... Close to half of the subjects were completely abstemious (much less than the general population) and just less than half of the commonly identified alcohol intake as a certain or presumed trigger for headache. The study illustrated that alcoholic drinks are commonly identified as migraine trigger factors and have an important effect on alcohol consumption behavior (117). ...
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Headache is the world's seventh most significant cause of disability-adjusted-life in people aged between 10 and 14 years. Therapeutic management is based on pharmacological approaches and lifestyle recommendations. Many studies show associations between each migraine-promoting lifestyle, behavioral triggers, frequency, and intensity of headaches. Nevertheless, the overall aspects of this topic lack any definitive evidence. Educational programs advise that pediatric patients who suffer from migraines follow a correct lifestyle and that this is of the utmost importance in childhood, as it will improve quality of life and assist adult patients in avoiding headache chronicity, increasing general well-being. These data are important due to the scarcity of scientific evidence on drug therapy for prophylaxis during the developmental age. The “lifestyle recommendations” described in the literature include a perfect balance between regular sleep and meal, adequate hydration, limited consumption of caffeine, tobacco, and alcohol, regular physical activity to avoid being overweight as well as any other elements causing stress. The ketogenic diet is a possible new therapeutic strategy for the control of headache in adults, however, the possible role of dietary factors requires more specific studies among children and adolescents. Educational programs advise that the improvement of lifestyle as a central element in the management of pediatric headache will be of particular importance in the future to improve the quality of life of these patients and reduce the severity of cephalalgic episodes and increase their well-being in adulthood. The present review highlights how changes in different aspects of daily life may determine significant improvements in the management of headaches in people of developmental age.
... Several studies asked participants whether they believed that alcohol triggers their migraine or tension-type headache [5][6][7][8], raising concerns of recall bias whereby participants are more likely to recall alcohol intake preceding a migraine and underreport the frequency of alcohol intake not followed by a headache. Therefore, we conducted a prospective cohort study of adults with episodic migraine to assess an individual's risk of headache on the day after alcohol intake compared to that same individual's risk on other days, adjusting for other behaviours that may be temporally associated with alcohol intake and headache occurrence. ...
Article
Purpose: To determine whether alcohol intake is associated with occurrence of headaches on the following day. Methods: In this prospective cohort study, adults with episodic migraine completed electronic diaries every morning and evening for at least six weeks in March 2016-October 2017. Every day, participants reported alcohol intake, lifestyle factors, and details about each headache. We constructed within-person fixed-effect models adjusted for time-varying factors to calculate odds ratios for the association between 1,2,3,4, or 5+ servings of alcohol and headache the following day. We also calculated the adjusted risk of headache the following day for each level of intake. Results: Among 98 participants who reported 825 headaches over 4,467 days, there was a statistically significant linear association (p-trend =0.03) between alcohol and headache the following day. Compared to no alcohol, 1-2 servings were not associated with headaches, but 5+ servings were associated with a 2.08-fold (95% confidence interval [CI] 1.16-3.73) odds of headache. The adjusted absolute risk of headaches was 20% (95%CI 19%-22%) on days following no alcohol compared with 33% (95%CI 22%-44%) on days following 5+ servings. Conclusion: 1-2 servings of alcoholic beverages were not associated with higher risk of headaches the following day, but 5+ servings were associated with higher risk. • Key Messages: • 1-2 servings of alcoholic beverages were not associated with a higher risk of headaches on the following day, but higher levels of intake may be associated with higher risk. • Five or more servings were associated with 2.08 times (95% confidence interval 1.16-3.73 the odds of headache on the following day. • The adjusted absolute risk of headaches was 20% (95%CI 19%-22%) on days following no alcohol consumption compared with 33% (95% CI 22%-44%) on days following 5+ servings.
... Up to 7 diverse prodromal neurological symptoms may occur, the four commonest being neck stiffness, mood changes, fatigue, and yawning [30], worsening the heterogeneity of any migraine cohort. Additionally, given the plethora and varied / cumulative effects of migraine triggers, i.e., exogenous or endogenous stimuli and situations leading to an attack [26,31,32,33], and their inconstant unknown physiologic impact on the migraineurincluding surprise and behavioural interactions [34], migraineurs are subject to unpredictable biological forces. Next, migraine visual auras are also very heterogeneous and pleomorphic across the positive as well as negative spectrum, either black-and-white or coloured, well-defined like the SS or otherwise, with or without fixed relationship to headache laterality [35]. ...
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Migraine is a common primary characteristically lateralizing cephalic painful disorder. The pathogenesis of migraine is not understood. Several theories and mechanisms of possible central brain-related origin of migraine with uncertain trajectories have found favour. Diverse pharmacologic drugs are used to abort acute attacks of migraine headache with varying success. Paradoxically, both vasoconstrictor (triptans) and vasodilator (magnesium) agents have been used. Drugs that do not freely cross the BBB and without definitive neural/neuronal influence (triptans, magnesium) are used to abort migraine attacks. While remaining in the centre stage with undisputed cranial vasoconstrictive action, the triptans offer no support to the currently in-vogue neuronal/neurovascular theory of migraine. Parenteral antiemetic dopaminergic antagonists form the most effective class of migraine abortive agents. Prochlorperazine i.v. is the most effective agent among the dopaminergic antagonists. Metoclopramide i.v. is an effective migraine abortive agent that also releases vasopressin (AVP). AVP offers important analgesic and vasomotor functions. AVP-related vasomotor and analgesic action of metoclopramide is elucidated in this review. Chlorpromazine (CPZ) has a definitive anti-migraine and retrobulbar analgesic action. CPZ blocks the voltage-gated sodium channel human Nav1.7. Less than 50% of patients in clinical trials respond to lasmiditan. There is no dose-response curve with increasing dosages and no clear benefit of a second dose of lasmiditan for rescue treatment. Use of placebo-controls without comparator drugs, as with lasmiditan trials, can be misleading. Analgesics, including NSAIDs, do not support the neuronal/neurovascular theory of origin of migraine. Clinical trials and meta-analyses cannot supplant the need for a reasonable degree of certitude about the nature of migraine. The critical role of the P-value in RCTs is under scrutiny. The site of action of all migraine abortive agents, including analgesics, is empirical and debatable. Emesis frequently aborts acute migraine headache attacks. Nausea/vomiting release AVP. In conjunction with intrinsic brain serotonergic and brain adrenergic activation, AVP release might play an important role in post-psychophysical non-oxidative stress-related migraine attacks as well as the typically delayed onset of headache of migraine. While psychosocial non-oxidative stress is ubiquitous, migraine affects approximately only 1/5 th to 1/6 th of humankind. Vasopressin-serotonergic-adrenergic nexus activation likely keeps migraine at bay in the vast majority of humans. Acute migraine attacks have a subtle onset, and, naturally and unpredictably wane over 4-72 hours. Uncertain decay of protean acute migraine headache attacks complicated by nausea/emesis with adaptive function creates a unique paradigm that complicates traditional studies. Data in migraine research are relatively soft and difficult to replicate precisely. CSD has a well-stablished neuronal as well as vascular protective effect in experimental animals. CSD does not offer any mechanistic insight for current migraine abortive drugs and is an illusory model for future drug development. The concept of adaptive mechanisms rationalizes abortive therapies for acute migraine attacks, and, is a first step in the evolution of a comprehensive pathophysiologic matrix. The future of abortive therapy rests on further evolution of the biology of migraine as well as an exclusive focus on the first (ophthalmic) division of the trigeminal nerve. 4 INDEX Abstract……………………………………………………………………Page 2-3 Introduction………………………………………………………………..Page 5-15
Article
Background It seems that diet is one of the main triggers of migraine; one of the most studied is alcohol, and also, over the years, red wine has been shown to trigger headaches. Therefore, this systematic review and meta-analysis aims to examine the strength of the association between wine consumption and migraine. Methods In this systematic review and meta-analysis, a search of MEDLINE (via PubMed), Scopus, Cochrane, and Web of Science databases was conducted to assess the association between wine consumption and migraine, covering baseline to December 2023. Pooled Odds Ratio (p-OR) were calculated using the DerSimonian and Laird methods. This study was previously registered in PROSPERO (CRD42024511115). The risk of bias was evaluated using The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results Five studies were included in this systematic review, and only four of them were in the meta-analysis. Using the DerSimonian and Laird method, the p-OR for the effect of wine consumption on migraine was 0.63 (95% CI 0.36–1.09). The included studies after the risk of bias assessment showed a moderate risk of bias. Conclusions The findings of this systematic review and meta-analysis indicate that there is no conclusive evidence to support an increased or decreased risk of migraine associated with wine consumption.
Article
Objective: To evaluate the relationship of diet and food components with the frequency of migraine attacks. Material and methods: Sixty patients (mean age 35.5±8.9 years, 85% women) with frequent episodic (EM) and chronic migraine (CM) were examined. Anamnestic information on food triggers was clarified for all participants. The patients kept a food diary for 7 days. For each meal, the content of food components (proteins, fats and carbohydrates) was calculated using tables and an electronic calculator of the Federal State Budgetary Institution «Nutrition and Biotechnology». Based on the data obtained, the average daily consumption of the main components of food and the ratio of their proportions to each other were calculated. The results of the data analysis were used to clarify the relationship between the individual characteristics of the diet in terms of food components and the severity of migraine. Results: The main food triggers of migraine were red wine (43.3%), coffee (35.0%), cheeses (21.7%), spices (20.0%), additives of nitrite or monosodium glutamate (20.0%). The average daily intake of carbohydrates had an inverse relationship (p=0.044, r=-0.275), and fats had a direct relationship (p=0.011, r=0.336) with the number of days with migraine. Conclusion: The results indicate the protective role of carbohydrate consumption in the development of migraine, which may correspond to the compensatory strategy of the body aimed at energy supply to the brain. Further study of the cerebral metabolic aspects of migraine should improve the understanding of its pathophysiology and chronicity, which will allow the formation of a correct diet preventive strategy.
Article
Objective To evaluate self‐reported substance user profiles for individuals with migraine and compare these to the general population. Background There is increasing attention to lifestyle influences such as substance use as presumed migraine triggers. Methods Data on substance use were collected by survey in a large migraine cohort and from the biannual survey in the general Dutch population for substances. A representative cohort of Dutch patients with migraine ( n = 5176) and the Dutch general population ( n = 8370) was included. Patients with migraine were subdivided into episodic (EM) and chronic migraine (CM). Substance consumption was compared between the general population and patients with migraine, and between migraine subgroups after standardization for sex and level of education. Results Included patients with migraine were 83.4% female (4319/5176) and had a mean (standard deviation) age of 44.8 (11.3) years. Patients with migraine reported less illicit drug use (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.42–0.55; p < 0.001), less current and lifetime smoking (OR 0.60, 95% CI 0.55–0.65; p < 0.001 and OR 0.75, 95% CI 0.71–0.79; p < 0.001), and less current alcohol consumption (OR 0.66, 95% CI 0.62–0.70; p < 0.001) compared with the general population. Prevalence of substance use was compared between CM and EM participants and showed higher illicit drug use (OR 1.73, 95% CI 1.11–2.69; p = 0.011), higher current smoking (OR 1.61, 95% CI 1.22–2.11; p < 0.001) but less alcohol use (OR 0.54, 95% CI 0.43–0.68; p < 0.001) for participants with CM compared with EM. No differences were found for a history of smoking (OR 1.18, 95% CI 0.92–1.50, p = 0.19). Conclusions Individuals with migraine are less likely to use illicit drugs, smoke, or drink alcohol compared with the general population. Patients with CM less often consume alcohol, while they more often use illicit drugs and smoke compared to those with EM.
Article
Objective: To assess the effect of food allergies on the course of migraine. Material and methods: Seventy patients with migraine, aged 21-56 years old, were examined using headache diary, MIDAS and VAS, studies of specific antibodies of the IgG4 class (delayed type food allergy) by immuno-enzyme analysis (ELISA), microbiological examination of a smear from the mucous membrane of the posterior wall of the oropharynx with mass spectrometry of microbial markers (MSMM) with the identification of 57 microorganisms. Results: We found an increase in specific IgG4 for a number of food allergens in most patients with migraine, of which 48.5% had a pronounced increase in IgG4 (>150 kEd/l) for at least one allergen (cow's milk - 13% patients, wheat flour - 5%, egg white - 47% or yolk - 26%, quail egg - 15%, sweet pepper - 6%), in 29% of people to several food allergens at once (all of them had chicken egg protein as one of the allergens). There was the association of IgG4 titers to wheat allergen with the severity of headache according to VAS (r-S=0.7; p=0.0046) in patients with the most severe, chronic migraine (17 people) and with an imbalance of the oropharyngeal microbiota, namely, concentration of pathological viruses Herpes spp. (rs=0.29; p=0.02), Epstein-Barr (rs=0.46; p=0.0002) and microscopic fungi (rs=0.39; p=0.0016), detected in these patients. Conclusion: We show for the first time the relationship between delayed-type food allergy and redistribution in the microbiome of the oropharynx of patients with migraine and once again confirm the role of delayed-type food allergy as a clinically significant factor influencing the course of migraine (its intensity and chronicity).
Article
Purpose While several studies have reported a relationship between chronic daily headache (CDH) and different dietary patterns, no study has investigated the association between CDH and the dietary inflammatory index (DII). This study aims to hypothesize that a higher DII score (proinflammatory diets) is associated with higher odds of CDH. Design/methodology/approach This cross-sectional study was performed using the baseline data of the Dena PERSIAN cohort study, including demographic information, body mass index, medical history, laboratory tests, sleep duration and blood pressure. The DII was computed based on the data collected by a valid 113-item food frequency questionnaire and a 127-item indigenous food questionnaire. The association between CDH and DII score was analyzed by simple and multiple logistic regression. Findings Out of 3,626 people included in the study, 23.1% had CDH. The median DII was −0.08 (interquartile range = 0.18). People in the third and fourth quartiles of DII (proinflammatory diet) had a 20% (odds ratio: 0.80; 95% confidence interval: 0.65–1) and a 25% (odds ratio: 0.75; 95% confidence interval: 0.61–0.94) lower chance of having CHD than those in the first quartile, respectively. After adjustment for confounding variables, this association did not remain statistically significant ( p > 0.05). Originality/value Although the analysis conducted without adjustment for medical history showed a significant association between proinflammatory diet and reduced CDH, considering the diverse etiology of different types of headaches and the paucity of studies in this area, further studies are needed to investigate the DII score of patients by the type of headache, its severity and duration.
Article
Purpose Migraine is a highly prevalent headache disorder, and intake of various nutrients and special diets may improve migraine symptoms. We aimed to clarify the association between nutritional status and migraine. Patients and methods We collected the data of 1838/8953 (migraineurs/all participants) from the National Health and Nutrition Examination Survey (NHANES) 1999–2004 cycle. We used weighted multivariable linear or logistic regression analyses to study the association between the prognostic nutritional index (PNI) and the occurrence of severe headache or migraine. Results After adjusting for confounding variables, we found that mild (PNI 45–50) or moderate to severe (PNI <45) malnutrition were associated with higher prevalence of severe headache or migraine (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.00–1.12, P = 0.004; OR 1.07, 95% CI 1.03–1.12, P < 0.001). In addition, we found that those with severe headache or migraine consumed less alcohol, dietary fiber, cholesterol, total folate, vitamin A, riboflavin, vitamin B6, vitamin B12, vitamin C, vitamin K, selenium, potassium, magnesium, and copper, and consumed more caffeine and theobromine than did those without severe headache or migraine. Conclusion The PNI is associated with migraine prevalence, and may thus serve as a predictor of migraine risk and highlights the potential of nutrition-based strategies for migraine prevention and treatment.
Article
Background: Clinical trials have demonstrated magnesium supplements to be effective for prophylactic treatment of migraine. Dietary magnesium intake of many Americans is known to be below nutritional recommendations, but typical magnesium intake from dietary sources in adults with migraine has not previously been evaluated. Objective: This study aimed to quantify dietary and total (diet + supplement) magnesium consumption of adults with migraine or severe headache in the United States, and to investigate the relationship between magnesium consumption levels and prevalence of migraine or severe headache. Methods: This analysis included cross-sectional data from 3626 participants, 20- to 50-years old in the National Health and Nutrition Examination Survey between 2001 and 2004. Presence of migraine or severe headache in the past 3 months was determined by questionnaire. Individuals responding affirmatively were classified as having migraine, and individuals reporting not experiencing migraine or severe headache were classified as controls. Dietary magnesium intake was determined from a 24-hour recall interview, supplemental magnesium intake was determined from the dietary supplements interview, and total magnesium intake was the sum of dietary and supplement intake. Results: Mean dietary consumption of magnesium was below the recommended dietary allowance (RDA) for both migraine (n = 905) and control groups (n = 2721). Attainment of the RDA through a combination of diet and supplements was associated with lower adjusted odds of migraine (odds ratio [OR] = 0.83, 95% confidence intervals [CIs] = 0.70, 0.99, p = 0.035). Magnesium consumption in the highest quartile (Q) was associated with lower odds of migraine than in the lowest Q for both dietary (OR = 0.76, 95% CI = 0.63, 0.92, p = 0.006) and total (OR = 0.78, 95% CI = 0.62, 0.99, p = 0.042) magnesium intake in adjusted models. Conclusion: These results suggest inadequate consumption of magnesium intake is associated with migraine in U.S. adults ages 20-50. Further prospective investigations are warranted to evaluate the role of dietary magnesium intake on migraine.
Article
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O presente estudo teve como objetivo analisar, por meio de revisão integrativa, a relação entre os hábitos alimentares e os fatores desencadeantes das crises de enxaqueca. Buscou-se artigos publicados nos últimos cinco anos em periódicos nacionais e internacionais nas seguintes bases de dados eletrônicos: SCIELO, Pubmed e LILACS, utilizando os seguintes descritores: enxaqueca, dieta e fatores desencadeantes. A busca resultou em 38 artigos, dos quais selecionou-se sete, após a aplicação dos critérios de inclusão e exclusão, para análise, interpretação e discussão. Desses estudos, o método quantitativo de pesquisa observado foi o de delineamento transversal observacional. Observou-se que nos estudos analisados descritos, grande parte do aumento das incidências de enxaqueca nas pessoas está relacionada basicamente pela má qualidade dos hábitos alimentares e estilo de vida dos mesmos. Entende-se que há relação entre os hábitos alimentares e as crises de enxaqueca. No entanto, é necessário um profissional qualificado para realizar uma avaliação nutricional, visando o equilíbrio do estado nutricional diante das individualidades de cada portador.
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The triggers of primary headaches have considerable significance for our understanding and management of headache and migraine. Triggers explain the variance in headaches – why they occur when they do. Trigger management is generally viewed as an important component of a comprehensive treatment approach for headaches. Historically, however, triggers have not had a prominent place in the headache literature. This situation began to change 20 to 30 years ago, and the pace of change has increased exponentially in recent times. Nevertheless, the field is beset with issues that have held it back from achieving more. This review will focus on elaborating those issues with the goal of suggesting ways forward. The first issue considered will be the definition of a trigger, and how specific triggers are labeled. Consideration will then be given to a classification system for triggers. The review will discuss next the evidence relating to whether self‐reported triggers can, indeed, precipitate headaches, and how the capacity to elicit headaches may be acquired or extinguished. Attention will be given to the very important clinical issue of trigger management. Finally, the pathways forward will be proposed. Perhaps the most useful thing to accomplish at this point in time would be agreement on a definition of headache triggers, a list of triggers, and a classification system for triggers. This would greatly assist in comparing research on triggers from different research groups as well as eliminating some of the issues identified in this review. An authoritative body such as the American Headache Society or the International Headache Society, could establish a multidisciplinary committee that would complete these tasks. Consideration should also be given to incorporating triggers into the International Classification of Headache Disorders as an axis or via the use of codes, as this would raise the profile of triggers in assessment and management.
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Background.: Pain has been qualified under four categories: nociception, perception of pain, suffering, and pain behaviors. Most of the literature on migraine has devoted attention to the first two. The aim of the present cohort study was to investigate patients with migraine enrolled at a tertiary care unit to study suffering and mental pain and identify potential risk factors for migraine. Methods.: An observational cross-sectional study was carried out on patients with chronic migraine (CM) and episodic migraine (EM), and healthy subjects (HS). The three groups were matched for age and sex. A comprehensive assessment of migraine disability, pain, psychiatric disorders, psychosomatic syndromes, depressive and anxious symptoms, euthymia, psychosocial variables, mental pain, and pain-proneness (PP) was performed. Results.: Three hundred subjects were enrolled (100 CM, 100 EM, and 100 HS). Based on the multiple regression analyses, those presenting PP (social impairment: odds ratio [OR] = 3.59, 95% confidence interval [CI] = 1.14-11.29; depressive symptoms: OR = 3.82, 95% CI = 1.74-8.41) were more likely to be CM than HS. Those with higher levels of PP (social impairment: OR = 4.04, 95% CI = 1.60-10.22; depressive symptoms: OR = 2.02, 95% CI = 1.26-3.24) were more likely to be EM than HS. Those presenting higher levels of mental pain were more likely to be CM than EM (OR = 1.45, 95% CI = 1.02-2.07). Conclusion.: Migraine is an unpleasant sensory and emotional experience associated with psychosocial manifestations that might contribute to the level of suffering of the individuals. Mental pain resulted to be the variable that most differentiated patients with CM from EM.
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Background: Observational studies have implicated migraine as a risk factor for coronary artery disease (CAD) and atrial fibrillation (AF), however it is unclear whether migraine is causal in this relationship. We investigated potential causality between genetically instrumented liability to migraine and cardiovascular disease outcomes using two-sample Mendelian randomization. Methods: The exposure comprised 35 independent, genome-wide significant genetic variants identified in the largest published migraine GWAS (Ncases = 59,674 / Ncontrols =316,078). The outcome datasets included GWAS of CAD (76,014 / 264,785), myocardial infarction (MI) (43,676 / 128,199), angina (10,618 / 326,065), and AF (60,620 / 970,216). MR estimates were generated using inverse-variance weighted random-effects meta-analysis, and further assessed with conventional MR sensitivity analyses. Results: We found evidence for a protective effect of migraine liability on CAD (odds ratio 0.86, 95% confidence interval 0.76-0.96, p=0.003), MI (0.86, 0.74-0.96, p=0.01), and angina (0.86, 0.75-0.99, p=0.04), but not on AF (1.00, 0.95-1.05, p=0.88). Analyses by migraine subtype showed an effect of migraine without aura on CAD risk (0.91, 0.84-0.99, p=0.014), but not of migraine with aura (1.00, 0.97-1.03, p=0.89). Sensitivity analyses indicated minimal bias by horizontal pleiotropy, outliers, reverse causality, or sample overlap. Conclusions: We identified a potentially protective effect of genetically instrumented liability to migraine on CAD risk. Mechanistic research investigating this link is warranted.
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The gut–brain axis refers to the bidirectional biochemical pathways linking the central nervous system with the gastrointestinal tract. Research suggests that changes in the micro-organisms found in the GI tract (the gut microbiota) can affect the brain's physiological, behavioural and cognitive functions. And through this so-called microbiota gut–brain axis it has been suggested that multiple neurological and psychiatric diagnoses (including Parkinson's disease, Alzheimer's disease, anxiety, depression and migraine) may be influenced by the micro-organisms of the gut. Migraine is a common and frequently debilitating condition. It has a global prevalence of approximately 15% and is responsible for millions of lost school and work days globally every month. Migraine is characterised by repeated, severe and protracted headaches, often preceded or accompanied by nausea, sensory hypersensitivity and visual disturbances. Migraine can be managed with analgesic and prophylactic drugs, although these are not always effective and can frequently have significant side effects. Some promising phase I/II studies suggest that certain combinations of probiotics could reduce the frequency and severity of migraine symptoms, with consequent reductions in medication use. Although research into microbiome-related treatments for migraine are in their infancy, further research into the field, including larger, phase III trials, could provide many millions of migraine patients with an alternative to traditional pharmacological means of managing migraine symptoms.
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Background: The gastrointestinal symptoms of migraine attacks have invited numerous dietary hypotheses for migraine etiology through the centuries. Substantial efforts have been dedicated to identifying dietary interventions for migraine attack prevention, with limited success. Meanwhile, mounting evidence suggests that the reverse relationship may also exist - that the biological mechanisms of migraine may influence dietary intake. More likely, the truth involves some combination of both, where the disease influences food intake, and the foods eaten impact the manifestations of the disease. In addition, the gut's microbiota is increasingly suspected to influence the migraine brain via the gut-brain axis, though these hypotheses remain largely unsubstantiated. Objective: This paper presents an overview of the strength of existing evidence for food-based dietary interventions for migraine, noting that there is frequently evidence to suggest that a dietary risk factor for migraine exists but no evidence for how to best intervene; in fact, our intuitive assumptions on interventions are being challenged with new evidence. We then look to the future for promising avenues of research, notably the gut microbiome. Conclusion: The evidence supports a call to action for high-quality dietary and microbiome research in migraine, both to substantiate hypothesized relationships and build the evidence base regarding nutrition's potential impact on migraine attack prevention and treatment.
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Third edition of the International Classification of Headache Disorders
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Background: As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. Methods: We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings: Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8–75·9 million [7·2%, 6·0–8·3]), 45·1 million (29·0–62·8 million [5·6%, 4·0–7·2]), 36·3 million (25·3–50·9 million [4·5%, 3·8–5·3]), 34·7 million (23·0–49·6 million [4·3%, 3·5–5·2]), and 34·1 million (23·5–46·0 million [4·2%, 3·2–5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3–3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0–11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862–11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018–19 228). Interpretation: The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.
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Purpose of review: In contrast to well-established relationships between headache and affective disorders, the role of alcohol use in primary headache disorders is less clear. This paper provides a narrative overview of research on alcohol use disorders (AUDs) in primary headache and presents a meta-analysis of the role of alcohol as a trigger (precipitant) of headache. Recent findings: The majority of studies on AUDs in headache have failed to find evidence that migraine or tension-type headache (TTH) is associated with increased risk for AUDs or problematic alcohol use. The meta-analysis indicated that 22% (95% CI: 17-29%) of individuals with primary headache endorsed alcohol as a trigger. No differences were found between individuals with migraine (with or without aura) or TTH. Odds of endorsing red wine as a trigger were over 3 times greater than odds of endorsing beer. An absence of increased risk for AUDs among those with primary headache may be attributable to alcohol's role in precipitating headache attacks for some susceptible individuals. Roughly one fifth of headache sufferers believe alcohol precipitates at least some of their attacks. Considerable study heterogeneity limits fine-grained comparisons across studies and suggests needs for more standardized methods for studying alcohol-headache relationships and rigorous experimental designs.
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Plaguing humans for more than two millennia, manifest on every continent studied, and with more than one billion patients having an attack in any year, migraine stands as the sixth most common cause of disability on the planet. The pathophysiology of migraine has emerged from a historical consideration of the “humors” through mid-20th century distraction of the now defunct Vascular Theory to a clear place as a neurological disorder. It could be said there are three questions: why, how, and when? Why: migraine is largely accepted to be an inherited tendency for the brain to lose control of its inputs. How: the now classical trigeminal durovascular afferent pathway has been explored in laboratory and clinic; interrogated with immunohistochemistry to functional brain imaging to offer a roadmap of the attack. When: migraine attacks emerge due to a disorder of brain sensory processing that itself likely cycles, influenced by genetics and the environment. In the first, premonitory, phase that precedes headache, brain stem and diencephalic systems modulating afferent signals, light-photophobia or sound-phonophobia, begin to dysfunction and eventually to evolve to the pain phase and with time the resolution or postdromal phase. Understanding the biology of migraine through careful bench-based research has led to major classes of therapeutics being identified: triptans, serotonin 5-HT1B/1D receptor agonists; gepants, calcitonin gene-related peptide (CGRP) receptor antagonists; ditans, 5-HT1F receptor agonists, CGRP mechanisms monoclonal antibodies; and glurants, mGlu5 modulators; with the promise of more to come. Investment in understanding migraine has been very successful and leaves us at a new dawn, able to transform its impact on a global scale, as well as understand fundamental aspects of human biology.
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Dietary triggers are commonly reported by patients with a variety of headaches, particularly those with migraines. The presence of any specific dietary trigger in migraine patients varies from 10 to 64 % depending on study population and methodology. Some foods trigger headache within an hour while others develop within 12 h post ingestion. Alcohol (especially red wine and beer), chocolate, caffeine, dairy products such as aged cheese, food preservatives with nitrates and nitrites, monosodium glutamate (MSG), and artificial sweeteners such as aspartame have all been studied as migraine triggers in the past. This review focuses the evidence linking these compounds to headache and examines the prevalence of these triggers from prior population-based studies. Recent literature surrounding headache related to fasting and weight loss as well as elimination diets based on serum food antibody testing will also be summarized to help physicians recommend low-risk, non-pharmacological adjunctive therapies for patients with debilitating headaches.
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Migraine is a debilitating neurological disorder affecting around one in seven people worldwide, but its molecular mechanisms remain poorly understood. There is some debate about whether migraine is a disease of vascular dysfunction or a result of neuronal dysfunction with secondary vascular changes. Genome-wide association (GWA) studies have thus far identified 13 independent loci associated with migraine. To identify new susceptibility loci, we carried out a genetic study of migraine on 59,674 affected subjects and 316,078 controls from 22 GWA studies. We identified 44 independent single-nucleotide polymorphisms (SNPs) significantly associated with migraine risk (P < 5 × 10(-8)) that mapped to 38 distinct genomic loci, including 28 loci not previously reported and a locus that to our knowledge is the first to be identified on chromosome X. In subsequent computational analyses, the identified loci showed enrichment for genes expressed in vascular and smooth muscle tissues, consistent with a predominant theory of migraine that highlights vascular etiologies.
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Alcoholic drinks (ADs) have been reported as a migraine trigger in about one-third of the migraine patients in retrospective studies. Some studies found that ADs trigger also other primary headaches. The studies concerning the role of ADs in triggering various types of primary headaches published after the International Headache Society classification criteria of 1988 were reviewed, and the pathophysiological mechanisms were discussed. Many studies show that ADs are a trigger of migraine without aura (MO), migraine with aura (MA), cluster headache (CH), and tension-type headache (TH). While data on MO and CH are well delineated, those in MA and TH are discordant. There are sparse reports that ADs are also triggers of less frequent types of primary headache such as familial hemiplegic migraine, hemicrania continua, and paroxysmal hemicrania. However, in some countries, the occurrence of alcohol as headache trigger is negligible, perhaps determined by alcohol habits. The frequency estimates vary widely based on the study approach and population. In fact, prospective studies report a limited importance of ADs as migraine trigger. If ADs are capable of triggering practically all primary headaches, they should act at a common pathogenetic level. The mechanisms of alcohol-provoking headache were discussed in relationship to the principal pathogenetic theories of primary headaches. The conclusion was that vasodilatation is hardly compatible with ADs trigger activity of all primary headaches and a common pathogenetic mechanism at cortical, or more likely at subcortical/brainstem, level is more plausible.
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Despite a century of research on complex traits in humans, the relative importance and specific nature of the influences of genes and environment on human traits remain controversial. We report a meta-analysis of twin correlations and reported variance components for 17,804 traits from 2,748 publications including 14,558,903 partly dependent twin pairs, virtually all published twin studies of complex traits. Estimates of heritability cluster strongly within functional domains, and across all traits the reported heritability is 49%. For a majority (69%) of traits, the observed twin correlations are consistent with a simple and parsimonious model where twin resemblance is solely due to additive genetic variation. The data are inconsistent with substantial influences from shared environment or non-additive genetic variation. This study provides the most comprehensive analysis of the causes of individual differences in human traits thus far and will guide future gene-mapping efforts. All the results can be visualized using the MaTCH webtool.
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Migraine is a common, multifactorial, disabling, recurrent, hereditary neurovascular headache disorder. It usually strikes sufferers a few times per year in childhood and then progresses to a few times per week in adulthood, particularly in females. Attacks often begin with warning signs (prodromes) and aura (transient focal neurological symptoms) whose origin is thought to involve the hypothalamus, brainstem, and cortex. Once the headache develops, it typically throbs, intensifies with an increase in intracranial pressure, and presents itself in association with nausea, vomiting, and abnormal sensitivity to light, noise, and smell. It can also be accompanied by abnormal skin sensitivity (allodynia) and muscle tenderness. Collectively, the symptoms that accompany migraine from the prodromal stage through the headache phase suggest that multiple neuronal systems function abnormally. As a consequence of the disease itself or its genetic underpinnings, the migraine brain is altered structurally and functionally. These molecular, anatomical, and functional abnormalities provide a neuronal substrate for an extreme sensitivity to fluctuations in homeostasis, a decreased ability to adapt, and the recurrence of headache. Advances in understanding the genetic predisposition to migraine, and the discovery of multiple susceptible gene variants (many of which encode proteins that participate in the regulation of glutamate neurotransmission and proper formation of synaptic plasticity) define the most compelling hypothesis for the generalized neuronal hyperexcitability and the anatomical alterations seen in the migraine brain. Regarding the headache pain itself, attempts to understand its unique qualities point to activation of the trigeminovascular pathway as a prerequisite for explaining why the pain is restricted to the head, often affecting the periorbital area and the eye, and intensifies when intracranial pressure increases.
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The notion of migraine attacks triggered by food and beverages has been posited for centuries. Red wine in particular has been acknowledged as a migraine trigger since antiquity when Celsus (25 B.C.-50 A.D.) described head pain after drinking wine. Since then, references to the relationship between alcohol ingestion and headache attacks are numerous. The most common initiator of these attacks among alcoholic beverages is clearly wine. The aim of this review is to present and discuss the available literature on wine and headache. A Medline search with the terms headache, migraine, and wine was performed. Data available on books and written material about wine and medicine as well as abstracts on alcohol, wine, and headache available in the proceedings of major headache meetings in the last 30 years were reviewed. In addition, available technical literature and websites about wine, grapes, and wine making were also evaluated. Full papers specifically on headache and wine are scarce. General literature related to medicine and wine is available, but scientific rigor is typically lacking. The few studies on wine and headache were mostly presented as abstracts despite the common knowledge and patients' complaints about wine ingestion and headache attacks. These studies suggest that red wine, but not white and sparkling wines, do trigger headache and migraine attacks independently of dosage in less than 30% of the subjects. Wine, and specifically red wine, is a migraine trigger. Non-migraineurs may have headache attacks with wine ingestion as well. The reasons for that triggering potential are uncertain, but the presence of phenolic flavonoid radicals and the potential for interfering with the central serotonin metabolism are probably the underlying mechanisms of the relationship between wine and headache. Further controlled studies are necessary to enlighten this traditional belief.
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Objective: It is well-known that migraine attacks can be precipitated by various stimuli. More than 50% of patients with migraine with aura (MA) know of at least one stimulus that always or often triggers their MA attacks. The objective of this study was to expose patients with MA to their self-reported trigger factors in order to assess the causal relation between trigger factors and attacks. Methods: We recruited 27 patients with MA who reported that bright or flickering light or strenuous exercise would trigger their migraine attacks. The patients were experimentally provoked by different types of photo stimulation, strenuous exercise, or a combination of these 2 factors. During and following provocation, the patients would report any aura symptoms or other migraine-related symptoms. Results: Of 27 provoked patients with MA, 3 (11%) reported attacks of MA following provocation. An additional 3 patients reported migraine without aura attacks. Following exercise, 4 out of 12 patients reported migraine, while no patients developed attacks following photo stimulation. Conclusion: Experimental provocation using self-reported natural trigger factors causes MA only in a small subgroup of patients with MA. Prospective confirmation is important for future studies of migraine trigger factors and in the clinical management of patients with migraine.
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The aim of this study was to investigate the association between headache and alcohol consumption among medical students. 480 medical students were submitted to a questionnaire about headaches and drinking alcohol. Headache was assessed by ID-Migraine and functional disability was evaluated with MIDAS. The evaluation of alcohol consumption was assessed with Alcohol Use Disorders Identification Test (AUDIT). There was significantly lower proportion of students with drinking problem among students with headache. This occurred both among students classified as having migraine and among those who had non-migrainous headache. There was not a correlation between functional disability of headache and AUDIT score. Our data suggest that having headache leads to a reduction in alcohol consumption among medical students regardless the degree of headache functional impact.
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To investigate whether sex-specific associations exist between migraine, lifestyle or socioeconomic factors. We distinguished between the subtypes migraine with aura (MA) and migraine without aura (MO). In 2002, a questionnaire containing validated questions to diagnose migraine and questions on lifestyle and socioeconomic factors was sent to 46,418 twin individuals residing in Denmark. 31,865 twin individuals aged 20-71 were included. The twins are representative of the Danish population with regard to migraine and other somatic diseases and were used as such in the present study. An increased risk of migraine was significantly associated with lower level of schooling and education, retirement, unemployment, and smoking. A decreased risk of migraine was significantly associated with heavy physical exercise and intake of alcohol. Direct comparison between the subtypes showed a decreased risk of MA compared to MO in subjects with low education or weekly intake of alcohol. The risk of MA was increased compared to MO in unemployed or retired subjects. Direct comparison between sexes showed a decreased risk of migraine for men compared to women in subjects who were low educated, unemployed or studying. The risk was increased for men compared to women in subjects with heavy physical exercise, intake of alcohol, and body mass index >25. Migraine was associated with several lifestyle and socioeconomic factors. Most associations such as low education and employment status were probably due to the negative effects of having migraine while others such as smoking were risk factors for migraine.
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Modification of lifestyle habits is a key preventive strategy for many diseases. The role of lifestyle for the onset of headache in general and for specific headache types, such as migraine and tension-type headache (TTH), has been discussed for many years. Most results, however, were inconsistent and data on the association between lifestyle factors and probable headache forms are completely lacking. We evaluated the cross-sectional association between different lifestyle factors and headache subtypes using data from three different German cohorts. Information was assessed by standardized face-to-face interviews. Lifestyle factors included alcohol consumption, smoking status, physical activity and body mass index. According to the 2004 diagnostic criteria, we distinguished the following headache types: migraine, TTH and their probable forms. Regional variations of lifestyle factors were observed. In the age- and gender-adjusted logistic regression models, none of the lifestyle factors was statistically significant associated with migraine, TTH, and their probable headache forms. In addition, we found no association between headache subtypes and the health index representing the sum of individual lifestyle factors. The lifestyle factors such as alcohol consumption, smoking, physical activity and overweight seem to be unrelated to migraine and TTH prevalence. For a judgement on their role in the onset of new or first attacks of migraine or TTH (incident cases), prospective cohort studies are required. Electronic supplementary material The online version of this article (doi:10.1007/s10194-010-0286-0) contains supplementary material, which is available to authorized users.
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The objective was to examine potential trigger factors of migraine and tension-type headache (TTH) in clinic patients and in subjects from the population and to compare the patients' personal experience with their theoretical knowledge. A cross-sectional study was carried out in a headache centre. There were 120 subjects comprising 66 patients with migraine and 22 with TTH from a headache outpatient clinic and 32 persons with headache (migraine or TTH) from the population. A semistructured interview covering biographic data, lifestyle, medical history, headache characteristics and 25 potential trigger factors differentiating between the patients' personal experience and their theoretical knowledge was used. The most common trigger factors experienced by the patients were weather (82.5%), stress (66.7%), menstruation (51.4%) and relaxation after stress (50%). The vast majority of triggers occurred occasionally and not consistently. The patients experienced 8.9+/-4.3 trigger factors (range 0-20) and they knew 13.2+/-6.0 (range 1-27). The number of experienced triggers was smallest in the population group (p=0.002), whereas the number of triggers known did not differ in the three study groups. Comparing theoretical knowledge with personal experience showed the largest differences for oral contraceptives (65.0 vs. 14.7%, p<0.001), chocolate (61.7 vs. 14.3%, p>0.001) and cheese (52.5 vs. 8.4%, p<0.001). In conclusion, almost all trigger factors are experienced occasionally and not consistently by the majority of patients. Subjects from the population experience trigger factors less often than clinic patients. The difference between theoretical knowledge and personal experience is largest for oral contraceptives, chocolate and cheese.
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In patients with diabetes mellitus (DM), there are changes in vascular reactivity and nerve conduction that may be relevant for migraine pathophysiology. However, previous studies on the relationship between headache and DM have shown conflicting results. The aim of the present study was to investigate a possible association between headache and DM in a large population-based cross-sectional study. Associations were assessed in multivariate analyses, estimating prevalence odds ratios (ORs) with 95% confidence intervals (CIs). Prevalence OR of migraine was lower amongst persons with DM compared with those without DM, the OR being 0.4 (95% CI: 0.2-0.9) for type 1 and 0.7 (95% CI: 0.5-0.9) for type 2 DM. Furthermore, OR of headache were lower amongst those with duration of DM > or = 13 years compared with those who had got DM the last 3 years, OR 0.6 (95% CI: 0.4-0.9). The analyses revealed no clear associations between non-migrainous headache and DM. The reason for the inverse relationship between migraine and DM is unknown, but might be related to pathophysiological abnormalities in patients with DM that protect against migraine.
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This study investigates the importance of alcohol as a migraine trigger factor, the prevalence of alcohol consumers and the mechanism of headache provocation. A MEDLINE search from 1988 to October 2007 was performed for "headache and alcohol", "headache and wine", "migraine and alcohol" and "migraine and wine". In retrospective studies, about one-third of the migraine patients reported alcohol as a migraine trigger, at least occasionally, but only 10% of the migraine patients reported alcohol as a migraine trigger frequently. Regional differences were reported, perhaps depending in part on alcohol habits. No differences were found between migraine and tension headache and different genders. However, prospective studies limit considerably the importance of alcohol as a trigger. Recent studies show that migraine patients consume less alcohol than controls. Red wine was reported to be the principal trigger of migraine, but other studies show that white wine or other drinks are more involved. Then, the discussion based on the different composition of the various alcoholic beverages, in order to discover the content of alcoholic drinks responsible for migraine attack, reflects this uncertainty. Biogenic amines, sulphites, flavonoid phenols, 5-hydroxytryptamine mechanisms and vasodilating effects are discussed. The fact that few headache patients cannot tolerate some alcoholic drinks does not justify the consideration that alcohol is a major trigger and the suggestion of abstinence. In fact, low doses of alcohol can have a beneficial effect on patients such as migraineurs, who were reported to have an increased risk of cardiovascular disease.
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The burden associated with headache is a major public health problem, the true magnitude of which has not been fully acknowledged until now. Globally, the percentage of the adult population with an active headache disorder is 47% for headache in general, 10% for migraine, 38% for tension-type headache, and 3% for chronic headache that lasts for more than 15 days per month. The large costs of headache to society, which are mostly indirect through loss of work time, have been reported. On the individual level, headaches cause disability, suffering, and loss of quality of life that is on a par with other chronic disorders. Most of the burden of headache is carried by a minority who have substantial and complicating comorbidities. Renewed recognition of the burden of headache and increased scientific interest have led to a better understanding of the risk factors and greater insight into the pathogenic mechanisms, which might lead to improved prevention strategies and the early identification of patients who are at risk.
Article
Background: Certain chronic diseases such as migraine result in episodic, debilitating attacks for which neither cause nor timing is well understood. Historically, possible triggers were identified through analysis of aggregated data from populations of patients. However, triggers common in populations may not be wholly responsible for an individual's attacks. To explore this hypothesis we developed a method to identify individual 'potential trigger' profiles and analysed the degree of inter-individual variation. Methods: We applied N = 1 statistical analysis to a 326-migraine-patient database from a study in which patients used paper-based diaries for 90 days to track 33 factors (potential triggers or premonitory symptoms) associated with their migraine attacks. For each patient, univariate associations between factors and migraine events were analysed using Cox proportional hazards models. Results: We generated individual factor-attack association profiles for 87% of the patients. The average number of factors associated with attacks was four per patient: Factor profiles were highly individual and were unique in 85% of patients with at least one identified association. Conclusion: Accurate identification of individual factor-attack profiles is a prerequisite for testing which are true triggers and for development of trigger avoidance or desensitisation strategies. Our methodology represents a necessary development toward this goal.
Article
Numerous lifestyle factors are blamed for triggering migraine attacks. The reliability of assessing these factors retrospectively is unknown. Therefore, retrospective and prospective assessments of lifestyle in general and of migraine triggers in particular were compared in patients with migraine. At baseline, the patients filled in two questionnaires covering the previous 90 days. Thereafter they kept a prospective 90-day diary. Questionnaires and diary included the same set of 45 factors. In the first questionnaire the patients assessed their lifestyle, in the second they rated for each factor the likelihood of triggering a migraine attack, and in the diary they recorded the daily presence of these factors irrespective of headache. Five categories were used for comparing frequencies in questionnaire and diary, defining agreement as identical categories in diary and questionnaire, minor disagreement and major disagreement as overestimation or underestimation by one category and two or more categories, respectively. In all, 327 patients (283 women, age 41.9 ± 12.1 years) who recorded 28 325 patient days were included. Calculating for each factor the percentage of patients with major disagreement the mean proportion was larger for trigger factors than for lifestyle (38.7% ± 6.6% vs. 16.9% ± 6.4%, P < 0.001). The proportion of factors showing major disagreement in more than 20% of the patients was 8.8% for lifestyle but 94.1% for trigger factors (P < 0.001). Comparing questionnaire and diary assessments of lifestyle and trigger factors in patients with migraine shows that questionnaire assessment of lifestyle is reliable, whereas trigger factors are overestimated and/or underestimated in retrospective questionnaires. © 2015 EAN.
Article
Migraine is a common, disabling, and undertreated episodic brain disorder that is more common in women than in men. Unbiased genome-wide association studies have identified 13 migraine-associated variants pointing at genes that cluster in pathways for glutamatergic neurotransmission, synaptic function, pain sensing, metalloproteinases, and the vasculature. The individual pathogenetic contribution of each gene variant is difficult to assess because of small effect sizes and complex interactions. Six genes with large effect sizes were identified in patients with rare monogenic migraine syndromes, in which hemiplegic migraine and non-hemiplegic migraine with or without aura are part of a wider clinical spectrum. Transgenic mouse models with human monogenic-migraine-syndrome gene mutations showed migraine-like features, increased glutamatergic neurotransmission, cerebral hyperexcitability, and enhanced susceptibility to cortical spreading depression, which is the electrophysiological correlate of aura and a putative trigger for migraine. Enhanced susceptibility to cortical spreading depression increased sensitivity to focal cerebral ischaemia, and blocking of cortical spreading depression improved stroke outcome in these mice. Changes in female hormone levels in these mice modulated cortical spreading depression susceptibility in much the same way that hormonal fluctuations affect migraine activity in patients. These findings confirm the multifactorial basis of migraine and might allow new prophylactic options to be developed, not only for migraine but potentially also for migraine-comorbid disorders such as epilepsy, depression, and stroke. Copyright © 2015 Elsevier Ltd. All rights reserved.
Article
Migraine attacks rarely occur spontaneously in the absence of any possible precipitating factors. A systematic literature review of 25 publications revealed a consistent set of stimuli that have been identified as factors associated with the onset of a migraine attack. The weighted average of the "Top 10" trigger factors was determined. Stress was cited as the overall most common migraine precipitating factor, which was identified as a trigger factor by 58 % of 7187 migraineurs. The incidence of migraine precipitating factors, across various populations globally, demonstrates the clinical consistency of migraine in the human population. Future efforts aimed at mitigating these precipitating factors have the potential to significantly improve migraine management. However, the current healthcare system is unlikely to be able to develop detailed personalized management plans. There is a need to develop a novel approach to the identification and management of multiple trigger factors in individual migraineurs.
Article
The influence of environmental factors on the clinical manifestation of migraine has been a matter of extensive debate over the past decades. Migraineurs commonly report foods, alcohol, meteorologic or atmospheric changes, exposure to light, sounds, or odors, as factors that trigger or aggravate their migraine attacks. In the same way, physicians frequently follow this belief in their recommendations in how migraineurs may reduce their attack frequency, especially with regard to the consumption of certain food components. Interestingly, despite being such a common belief, most of the clinical studies have shown conflicting results. The aim of the review is to critically analyze clinical and pathophysiological facts that support or refute a correlation between certain environmental stimuli and the occurrence of migraine attacks. Given the substantial discrepancy between patients' reports and objective clinical data, the methodological difficulties of investigating the link between environmental factors and migraine are highlighted.
Article
This project aims to investigate the role of alcoholic drinks (ADs) as triggers for primary headaches. Patients followed in the Headache Centre and presenting with migraine without aura, migraine with aura (MA), chronic migraine (CM), and tension-type headache (TH) were asked if their headache was precipitated by AD and also about their alcohol habits. Individual characteristics and drink habits were evaluated within two binary logistic models. About one half (49.7%) of patients were abstainers, 17.6% were habitual consumers, and 32.5% were occasional consumers. Out of 448 patients, only 22 (4.9%), all with migraine, reported AD as a trigger factor. None of 44 patients with MA and none of 47 patients with TH reported AD as a trigger factor. Among those patients with migraine who consume AD, only 8% reported that AD can precipitate their headache. Multivariate analyses showed that AD use, both occasional and habitual, is unrelated to TH. Moreover, analysis performed among migraine patients, points out that occasional and habitual drinkers have a lower risk of presenting with CM than abstainers, although statistical significance occurred only among occasional drinkers. Only 3% of migraine patients who abstain from AD reported that they do not consume alcohol because it triggers their headache. Our study shows that AD acts as headache triggers in a small percentage of migraine patients. Differing from some prior studies, our data suggest that AD do not trigger MA and TH attacks. Moreover, the percentage of abstainers in our sample is higher compared with that reported in general population surveys.
Article
The objective of this study was to explore the conditions necessary to assign causal status to headache triggers. The term “headache trigger” is commonly used to label any stimulus that is assumed to cause headaches. However, the assumptions required for determining if a given stimulus in fact has a causal-type relationship in eliciting headaches have not been explicated. A synthesis and application of Rubin's Causal Model is applied to the context of headache causes. From this application, the conditions necessary to infer that 1 event (trigger) causes another (headache) are outlined using basic assumptions and examples from relevant literature. Although many conditions must be satisfied for a causal attribution, 3 basic assumptions are identified for determining causality in headache triggers: (1) constancy of the sufferer, (2) constancy of the trigger effect, and (3) constancy of the trigger presentation. A valid evaluation of a potential trigger's effect can only be undertaken once these 3 basic assumptions are satisfied during formal or informal studies of headache triggers. Evaluating these assumptions is extremely difficult or infeasible in clinical practice, and satisfying them during natural experimentation is unlikely. Researchers, practitioners, and headache sufferers are encouraged to avoid natural experimentation to determine the causal effects of headache triggers. Instead, formal experimental designs or retrospective diary studies using advanced statistical modeling techniques provide the best approaches to satisfy the required assumptions and inform causal statements about headache triggers.
Article
Objectives: The aim of this study was to examine factors increasing and decreasing the risk of occurrence of migraine aura and of headache and migraine not associated with aura (HoA, MoA) prospectively by means of a daily diary. Methods: Of 327 patients with migraine completing a comprehensive diary up to 90 days, we selected all patients who recorded at least 1 episode of migraine aura. To find risk indicators and triggers of aura, HoA, and MoA, we analyzed 56 variables and calculated univariate and multivariate generalized linear mixed models. Results: Fifty-four patients recorded a total of 4562 patient days including 354 days with migraine aura. In the multivariate analysis, the risk of aura was statistically significantly increased by smoking, menstruation, and hunger, and it was decreased by holidays and days off. The risk of HoA and/or MoA was increased during menstruation, by psychic tension, tiredness, and odors, and it was decreased by smoking. Conclusion: Menstruation is the most prominent factor increasing the risk of aura as well as that of HoA and MoA. Smoking shows the most striking difference increasing the risk of aura, but decreasing the risk of HoA and MoA.
Article
To assess validity of a self-administered web-based migraine-questionnaire in diagnosing migraine aura for the use of epidemiological and genetic studies. Self-reported migraineurs enrolled via the LUMINA website and completed a web-based questionnaire on headache and aura symptoms, after fulfilling screening criteria. Diagnoses were calculated using an algorithm based on the International Classification of Headache Disorders (ICHD-2), and semi-structured telephone-interviews were performed for final diagnoses. Logistic regression generated a prediction rule for aura. Algorithm-based diagnoses and predicted diagnoses were subsequently compared to the interview-derived diagnoses. In 1 year, we recruited 2397 migraineurs, of which 1067 were included in the validation. A seven-question subset provided higher sensitivity (86% vs. 45%), slightly lower specificity (75% vs. 95%), and similar positive predictive value (86% vs. 88%) in assessing aura when comparing with the ICHD-2-based algorithm. This questionnaire is accurate and reliable in diagnosing migraine aura among self-reported migraineurs and enables detection of more aura cases with low false-positive rate.
Article
The aim of this study was to evaluate and define the triggers of the acute migraine attack. Patients rated triggers on a 0-3 scale for the average headache. Demographics, prodrome, aura, headache characteristics, postdrome, medication responsiveness, acute and chronic disability, sleep characteristics and social and personal characteristics were also recorded. One thousand two hundred and seven International Classification of Headache Disorders-2 (1.1-1.2, and 1.5.1) patients were evaluated, of whom 75.9% reported triggers (40.4% infrequently, 26.7% frequently and 8.8% very frequently). The trigger frequencies were stress (79.7%), hormones in women (65.1%), not eating (57.3%), weather (53.2%), sleep disturbance (49.8%), perfume or odour (43.7%), neck pain (38.4%), light(s) (38.1%), alcohol (37.8%), smoke (35.7%), sleeping late (32.0%), heat (30.3%), food (26.9%), exercise (22.1%) and sexual activity (5.2%). Triggers were more likely to be associated with a more florid acute migraine attack. Differences were seen between women and men, aura and no aura, episodic and chronic migraine, and between migraine and probable migraine.
Article
Patients with migraine who believed that red wine but not alcohol in general had a headache-provoking effect on them were challenged either with red wine or with a vodka and diluent mixture of equivalent alcohol content, both consumed cold out of dark bottles to disguise colour and flavour. The red wine, which had a negligible tyramine content, provoked a typical migraine attack in 9 of 11 such patients, whereas none of the 8 challenged with vodka had an attack. Neither red wine nor vodka provoked such episodes in other migrainous subjects or controls. These findings show that red wine contains a migraine-provoking agent that is neither alcohol nor tyramine.
Article
The concept of dietary migraine as a clinical entity remains controversial. We review here such objective evidence that has been put forward for its existence. Red wine, in particular, is commonly alleged to initiate attacks in susceptible individuals. We discuss how some of its recently described pharmacological properties might trigger off the sequence of events leading to migrainous headache.
Article
The clinical characteristics of migraine without aura (MO) and migraine with aura (MA) were compared in 484 migraineurs from the general population. We used the criteria of the International Headache Society. The lifetime prevalence of MO was 14.7% with a M:F ratio of 1:2.2; that of MA was 7.9% with a M:F ratio of 1:1.5. The female preponderance was significant in both MO and MA. The female preponderance was present in all age groups in MA, but was first apparent after menarche in MO, suggesting that female hormones are an initiating factor in MO, but not likely so in MA. The age at onset of MO followed a normal distribution, whereas the age at onset of MA was bimodally distributed, which could be explained by a composition of two normal distributions. The estimated separation between the two groups of MA was at age 26 years among the females and age 31 years among the males. The observed number of persons with co-occurrence of MO and MA was not significantly different from the expected number. The specificity and importance of premonitory symptoms are questioned, but prospective studies are needed. Bright light was a precipitating factor in MA, but not in MO. Menstruation was a precipitating factor in MO, but not likely in MA. Both MO and MA improved during pregnancy. The clinical differences indicate that MO and MA are distinct entities.
Article
To describe the distribution of migraine and its subtypes in the general population. Previous population-based studies are limited by small samples or a narrow age range, do not provide prevalence estimates of migraine with and without aura, or underestimate prevalence by not accounting for patients missed as a result of using imperfect screening instruments. The participants in the Genetic Epidemiology of Migraine Study were comprised of 6,491 adults, age 20 to 65 years, selected randomly from two county population registries in the Netherlands to participate in a general health survey (52.7% response). Migraineurs were identified as follows: All participants were screened on headache history. Those meeting screen-positive criteria were given a detailed questionnaire on headache. A total of 1,292 randomly selected screen-positives (83% of screen-positives) and 197 randomly selected screen-negatives (5% of screen-negatives) were administered a semistructured clinical interview by telephone. Final diagnosis met 1988 International Headache Society criteria. Prevalence of migraine was estimated for sex and 5-year age strata. The lifetime prevalence of migraine in women was 33% and the 1-year prevalence of migraine in women was 25%. In men, the lifetime prevalence was 13.3% and the 1-year prevalence was 7.5%. Among patients with migraine in the past year, 63.9% had migraine without aura, 17.9% had migraine with aura, and 13.1% had migraine both with and without aura. The prevalence of migraine was significantly higher in women and not associated with socioeconomic status. Migraineurs suffered a median of 12 migraine attacks per year; 25% had at least two attacks per month. The prevalence of migraine is higher then previously reported. The coexistence of migraine with and without aura occurs frequently and has implications for future studies on the genetics of migraine.
Article
The present review of epidemiologic studies on migraine and headache in Europe is part of a larger initiative by the European Brain Council to estimate the costs incurred because of brain disorders. Summarizing the data on 1-year prevalence, the proportion of adults in Europe reporting headache was 51%, migraine 14%, and 'chronic headache' (i.e. > or =15 days/month or 'daily') 4%. Generally, migraine, and to a lesser degree headache, are most prevalent during the most productive years of adulthood, from age 20 to 50 years. Several European studies document the negative influence of headache disorders on the quality of life, and health-economic studies indicate that 15% of adults were absent from work during the last year because of headache. Very few studies have been performed in Eastern Europe, and there are also surprisingly little data on tension-type headache from any country. Although the methodology and the quality of the published studies vary considerably, making direct comparisons between different countries difficult, the present review clearly demonstrates that headache disorders are extremely prevalent and have a vast impact on public health. The data collected should be used as arguments to increase resources to headache research and care for headache patients all over the continent.
Headache Classification Committee of the International Headache Society (IHS)
Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia 2018; 38: 1-211.