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Clinical features of episodic migraine and transformed migraine: a comparative study
Galego, José Carlos Busto;Cipullo, José Paulo;Cordeiro, José Antonio;Tognola, Waldir Antonio;
Arquivos de Neuro-Psiquiatria , 2002, DOI: 10.1590/S0004-282X2002000600005
Abstract: transformed migraine (tm) is one of the most frequent types of chronic daily headache. eighty patients: 40 with episodic migraine (em) and 40 with tm with ages ranging from 18 to 60 years old were studied. females were the majority. at first examination, the mean age was similar in both groups. the initial age of migraine attacks was significantly smaller in the tm group. time history of episodic attacks was similar in both groups. in the em group, the headache was predominantly located on only one side of the head; whereas in the tm group, on more than one side. there was variation in the character of pain and intensity in the tm group. nocturnal awakening with headache, aura and family history did not show significant association with em or tm. the tm was distinguished from the em in relation to the frequency, location and pain intensity of the headache. patients with early migraine headache onset may exhibit a further risk of developing tm.
Clinical features of episodic migraine and transformed migraine: a comparative study
Galego José Carlos Busto,Cipullo José Paulo,Cordeiro José Antonio,Tognola Waldir Antonio
Arquivos de Neuro-Psiquiatria , 2002,
Abstract: Transformed migraine (TM) is one of the most frequent types of chronic daily headache. Eighty patients: 40 with episodic migraine (EM) and 40 with TM with ages ranging from 18 to 60 years old were studied. Females were the majority. At first examination, the mean age was similar in both groups. The initial age of migraine attacks was significantly smaller in the TM group. Time history of episodic attacks was similar in both groups. In the EM group, the headache was predominantly located on only one side of the head; whereas in the TM group, on more than one side. There was variation in the character of pain and intensity in the TM group. Nocturnal awakening with headache, aura and family history did not show significant association with EM or TM. The TM was distinguished from the EM in relation to the frequency, location and pain intensity of the headache. Patients with early migraine headache onset may exhibit a further risk of developing TM.
Towards dynamical network biomarkers in neuromodulation of episodic migraine  [PDF]
Markus A. Dahlem,Sebastian Rode,Arne May,Naoya Fujiwara,Yoshito Hirata,Kazuyuki Aihara,Jürgen Kurths
Quantitative Biology , 2013, DOI: 10.2478/s13380-013-0127-0
Abstract: Computational methods have complemented experimental and clinical neursciences and led to improvements in our understanding of the nervous systems in health and disease. In parallel, neuromodulation in form of electric and magnetic stimulation is gaining increasing acceptance in chronic and intractable diseases. In this paper, we firstly explore the relevant state of the art in fusion of both developments towards translational computational neuroscience. Then, we propose a strategy to employ the new theoretical concept of dynamical network biomarkers (DNB) in episodic manifestations of chronic disorders. In particular, as a first example, we introduce the use of computational models in migraine and illustrate on the basis of this example the potential of DNB as early-warning signals for neuromodulation in episodic migraine.
Midriasis unilateral posterior a la anestesia: reporte de un caso Case report: Unilateral Mydriasis after anesthesia  [cached]
César Lora
Revista Colombiana de Anestesiología , 2010,
Abstract: Se trata de un paciente de sexo masculino de cinco a os de edad y 13 kg de peso, con diagnóstico de caries dental y programado para tratamiento odontológico integral. Al retirar la cinta adhesiva de los ojos, se observó Midriasis derecha fija, sin reflejo a la luz, y sin otros cambios en el examen físico. Al cuarto día fue evaluado por neurología, con mejoría del tama o pupilar. En el quinto día, la pupila volvió a su tama o natural, sin secuelas, según el seguimiento y la información de un familiar. A five year old male boy weighing 13 kg who had dental cavities was scheduled for a complete dental treatment. When the protective tape of the eyes was removed, a fixed right Mydriasis without any light response was observed, without any other changes in the physical examination. On the fourth day, he was assessed by neurology presenting an improvement and the pupillary size. On the fifth day the pupil returned to normal size without any sequela according to family information. A pediatric anesthesia case with unilateral Mydriasis lasting one week after surgery is presented. The differential diagnostic processes are discussed.
Sleep Quality and Depression in Episodic and Chronic Migraine Sufferers
N?ropsikiyatri Ar?ivi , 2010,
Abstract: Objective: In this study, depression and sleep quality were investigated inepisodic migraine and chronic migraine patients in order to determine the relationshipbetween them and to find clues to treatment.Methods: Sixty-six migraine and sixty-five chronic migraine patients wereincluded in the study. Sleep latency, maintaining sleep, total sleeping time andrefreshing quality of sleep were investigated and the Beck DepressionInventory was carried out. Variables were categorized and differencesbetween the migraine and chronic migraine patients were evaluated.Results: Rate of depression was greater in the chronic migraine patients.Maintenance of sleep was more difficult in the chronic migraine patients; theirtotal sleep time was shorter and a greater proportion was awaking tired in themorning compared to the migraine patients. When the depressed group wascompared with the non-depressed group, the time for falling asleep again waslonger and they were awaking tired.Conclusion: In the treatment of patients who show tendency to have frequentheadache, a priority should be given to the headache, since the clinical statuswould probably get more complex when it is accompanied with sleep disorderand depression. (Archives of Neuropsychiatry 2010; 47: 196-200)
Migraine generator network and spreading depression dynamics as neuromodulation targets in episodic migraine  [PDF]
Markus A. Dahlem
Quantitative Biology , 2013, DOI: 10.1063/1.4813815
Abstract: Migraine is a common disabling headache disorder characterized by recurrent episodes sometimes preceded or accompanied by focal neurological symptoms called aura. The relation between two subtypes, migraine without aura (MWoA) and migraine with aura (MWA), is explored with the aim to identify targets for neuromodulation techniques. To this end, a dynamically regulated control system is schematically reduced to a network of the trigeminal nerve, which innervates the cranial circulation, an associated descending modulatory network of brainstem nuclei, and parasympathetic vasomotor efferents. This extends the idea of a migraine generator region in the brainstem to a larger network and is still simple and explicit enough to open up possibilities for mathematical modeling in the future. In this study, it is suggested that the migraine generator network (MGN) is driven and may therefore respond differently to different spatio-temporal noxious input in the migraine subtypes MWA and MWoA. The noxious input is caused by a cortical perturbation of homeostasis, known as spreading depression (SD). The MGN might even trigger SD in the first place by a failure in vasomotor control. As a consequence, migraine is considered as an inherently dynamical disease to which a linear course from upstream to downstream events would not do justice. Minimally invasive and noninvasive neuromodulation techniques are briefly reviewed and their rational is discussed in the context of the proposed mechanism.
Hot spots and labyrinths: Why neuromodulation devices for episodic migraine should be personalized  [PDF]
Markus A Dahlem,Bernd Schmidt,Ingo Bojak,Sebastian Boie,Frederike Kneer,Nouchine Hadjikhani,Jürgen Kurths
PeerJ , 2015, DOI: 10.7287/peerj.preprints.515v1
Abstract: Stimulation protocols for medical devices should be rationally designed. For episodic migraine with aura we outline model-based design strategies towards preventive and acute therapies using stereotactic neuromodulation. To this end, we regard a localized spreading depression (SD) wave segment as a central element in migraine pathophysiology. To describe nucleation and propagation features of the SD wave segment, we define the new concepts of cortical hot spots and labyrinths, respectively. In particular, we firstly focus exclusively on curvature-induced dynamical properties by studying a generic reaction-diffusion model of SD on the folded cortical surface. This surface is described with increasing level of details, including finally personalized simulations using patient's magnetic resonance imaging (MRI) scanner readings. At this stage, the only relevant factor that can modulate nucleation and propagation paths is the Gaussian curvature, which has the advantage of being rather readily accessible by MRI. We conclude with discussing further anatomical factors, such as areal, laminar, and cellular heterogeneity, that in addition to and in relation to Gaussian curvature determine the generalized concept of cortical hot spots and labyrinths as target structures for neuromodulation.Our numerical simulations suggest that these target structures are like fingerprints, they are individual features of each migraine sufferer. The goal in the future will be to provide individualized neural tissue simulations. These simulations should predict the clinical data and therefore can also serve as a test bed for exploring stereotactic neuromodulation.
Getting a Grip on Memory: Unilateral Hand Clenching Alters Episodic Recall  [PDF]
Ruth E. Propper, Sean E. McGraw, Tad T. Brunyé, Michael Weiss
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0062474
Abstract: Unilateral hand clenching increases neuronal activity in the frontal lobe of the contralateral hemisphere. Such hand clenching is also associated with increased experiencing of a given hemisphere’s “mode of processing.” Together, these findings suggest that unilateral hand clenching can be used to test hypotheses concerning the specializations of the cerebral hemispheres during memory encoding and retrieval. We investigated this possibility by testing effects of unilateral hand clenching on episodic memory. The hemispheric Encoding/Retrieval Asymmetry (HERA) model proposes left prefrontal regions are associated with encoding, and right prefrontal regions with retrieval, of episodic memories. It was hypothesized that right hand clenching (left hemisphere activation) pre-encoding, and left hand clenching (right hemisphere activation) pre-recall, would result in superior memory. Results supported the HERA model. Also supported was that simple unilateral hand clenching can be used as a means by which the functional specializations of the cerebral hemispheres can be investigated in intact humans.
Factors for Progression and Chronification of Episodic Migraine: One-year Face-to-face Follow-up Study  [PDF]
Meral SEFERO?LU,Necdet KARLI,Mehmet ZARIFO?LU,?i?dem ?EN
Journal of Neurological Sciences , 2012,
Abstract: Objectives: To investigate the factors influencing progression and chronification of episodic migraine, we conducted a 12-month face to face follow-up study of episodic migraine patients.Methods: One hundred eighty patients with episodic migraine were enrolled. 120 parameters were analyzed including demographic factors, social and life-style features, comorbid medical illnesses and headache characteristics. After the first evaluation, all patients was scheduled to a structured face to face interview at 3-months interval for one-year.Results: Thirty-two (17,7%) patients developed chronic daily headache. Four out of 32 (2,2%) had definite chronic migraine. Low education level, obesity, greater tea consumption (≥4 cups/daily), predominantly hot and spicy diet, high headache frequency, long duration of headache and presence of allodynia at baseline, and more days with symptomatic drug intake were significant risk factors for progression and chronification of migraine. Cox regression analysis revealed triptan and NSAID intake, hot and spicy eating habit and allodynia as risk factors for chronification.Conclusion: Higher amount of tea consumption, hot and spicy diet appeared to be new risk factors for chronification of migraine. Weight gain is one of the most important risk factors. Patients should be warned about the risk factors to prevent chronification.
Excitatory neurotransmitters in brain regions in interictal migraine patients
Andrew Prescot, Lino Becerra, Gautam Pendse, Shannon Tully, Eric Jensen, Richard Hargreaves, Perry Renshaw, Rami Burstein, David Borsook
Molecular Pain , 2009, DOI: 10.1186/1744-8069-5-34
Abstract: 2D J-resolved proton magnetic resonance spectroscopy (1H-MRS) data were acquired at 4.0 Tesla (T) from the ACC and insula in 10 migraine patients (7 women, 3 men, age 43 ± 11 years) and 8 age gender matched controls (7 women, 3 men, age 41 ± 9 years).Standard statistical analyses including analysis of variance (ANOVA) showed no significant metabolite differences between the two subject cohorts in the ACC nor the insula. However, linear discriminant analysis (LDA) introduced a clear separation between subject cohorts based on N-acetyl aspartylglutamate (NAAG) and glutamine (Gln) in the ACC and insula.These results are consistent with glutamatergic abnormalities in the ACC and insula in migraine patients during their interictal period compared to healthy controls. An alteration in excitatory amino acid neurotransmitters and their derivatives may be a contributing factor for migraineurs for a decrease in sensitivity for migraine or a consequence of the chronic migraine state. Such findings, if extrapolated to other regions of the brain would offer new opportunities to modulate central system as interictal or preemptive medications in these patients.Migraine is a neurobiologic disorder that affects about 27 million women and 10 million men in the US [1]. Migraine attacks manifest themselves from childhood (usually 8–12 yrs.) to old age, with a decline among women during the postmenopausal years. Migraine is a unilateral throbbing headache that lasts 4–72 hours; it is idiopathic, episodic and recurrent [2]. Although the causes of migraine are unknown, it is generally thought that the pain originates from chemical activation of sensory nerves that supply intracranial blood vessels and the meninges [3]. However, the long-term consequences of repeated intermittent attacks of acute migraine on brain function, whatever the origin of the syndrome is, are not well defined.Two major unanswered questions in the field of migraine relate to (1) Is there an underlying basis for the
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