Benefits of multi-day supplementation with probiotic kefir in Rasmussen encephalitis: the first case report.

INTRODUCTION: Rasmussen encephalitis (RE) is a rare inflammatory disease, characterized by unilateral hemispheric atrophy, focal intractable seizures, progressive hemiparesis, and neurological deficits. CASE REPORT: The patient is a young man under pharmacotherapy for epilepsy, exhibiting classical abnormal movements, which are consider typical hallmarks of RE. During clinical care sessions, he presented many episodes of tonic-clonic seizures involving sudden loss of consciousness followed by a post-ictal phase with weakness and interaction difficulty. During the kefir supplementation, the patient presented only short-term absence seizures, quickly returning to activities. Additionally, he presented cognitive and language improvement, being more responsive to commands. The daily diary control of patient's mother and caregiver at school reported an impressive reduction in number and severity of seizures, becoming less aggressive and more involved in school activities. The serum biochemical markers showed that kefir administration caused a significant decrease of pro-inflammatory and a simultaneous increase of anti-inflammatory cytokine levels. In parallel, after treatment, this probiotic reduced reactive oxygen species levels, increased NO bioavailability, revealing antiapoptotic and antigenotoxic effects. Regarding the microbiological analysis, kefir increased Lactobacillus and Bifidobacterium species. CONCLUSION: To our knowledge, this is the first case reporting remarkable beneficial effects of the probiotic kefir in RE. This case report strongly suggests kefir supplementation as a potential and safe-effective adjuvant therapeutic strategy in the control and treatment of RE.

Increased serum levels of interleukin-8 in patients with tension-type headache.

BACKGROUND AND OBJECTIVES: The pathophysiology of tension-type headache is not well understood. Increased peripheral levels of pro-inflammatory cytokines may act as mediators of several chronic pain disorders. The aim of the present study was to investigate the peripheral levels of chemokines in patients with tension-type headache. METHODS: This was a cross sectional study evaluating serum levels of chemokines in age and sex-matched tension-type headache patients, ictally and interictally, and control participants. Beck Depression and Anxiety Inventories were recorded. Serum levels of monocyte chemoattractant protein-1, macrophage inflammatory protein 1α, regulated on activation, normal T cell expressed and secreted, eotaxin, eotaxin-2, interleukin-8, interferon gamma induced protein-10 were measured by enzyme-linked immunosorbent assay. RESULTS: A total of 96 participants (48 tension-type headache, 48 controls) were included. Interleukin-8 levels were significantly increased in patients with tension-type headache when compared to controls (413.8 (123.4-1756.3) and 329 (107.8-955.6), respectively, P = 0.025). Anxiety and depression scores were higher in patients with tension-type headache but interleukin-8 increase in tension-type headache patients persisted after controlling for anxiety and depression symptoms. Patients with headache at the time of assessment had increased monocyte chemoattractant protein-1 levels when compared with patients without headache (2809.3 (1101-6122.2) and 1630.2 (669.3-31056.8), respectively P = 0.026). Patients with episodic and chronic tension-type headache had no significant differences in serum chemokines levels. CONCLUSION: Interleukin-8 was increased in tension-type headache and monocyte chemoattractant protein-1 was higher in tension-type headache patients with headache, suggesting that pro-inflammatory mechanisms may participate in tension-type headache pathophysiology.

Increased interictal serum levels of CXCL8/IL-8 and CCL3/MIP-1α in migraine.

Inflammatory mediators have been studied in migraine pathophysiology; however, their role is not yet well established. The aim of the present study was to investigate interictal chemokine levels and its association with clinical parameters and psychiatric comorbidities in migraine patients compared with controls. This was a cross-sectional study including age and gender matched migraine patients and controls. Beck Depression and Anxiety Inventories, Headache Impact Test, and Allodynia Symptom Checklist were recorded. Chemokines were measured by ELISA. Forty-nine migraine patients and forty-nine controls without headache were included. CXCL8/IL-8 and CCL3/MIP-1α levels were significantly higher among patients with migraine (P = 0.039 and 0.02, respectively) even after controlling for anxiety and depression scores. Chemokine levels were not correlated with migraine impact as well as allodynia scores. CXCL8/IL-8 and CCL3/MIP-1 α levels were raised in migraine, independently of psychiatric comorbidities, migraine impact, and allodynia.

Altered cardiovascular reactivity to mental stress in patients with multiple sclerosis.

Cold pressure test (CPT) and mental stress test (MST) are distinct tests usually leading to blood pressure (BP) and heart rate (HR) increase. Their patterns in multiple sclerosis (MS) are still unknown. This study assessed cardiovascular reactivity to MST and CPT in patients with MS and controls. MST was performed with Stroop test card. CPT was performed with cold stimulus. The BP and HR were digitally recorded at rest and test phases. The delta (Δ) and the variance of BP and HR were compared between patients and controls. Patients with MS had lower Δ of diastolic BP and HR induced by MST than controls. There were no differences between patients and controls with CPT. The reduced autonomic reactivity to MST but not with CPT suggests that specific central nervous system pathways involved in MST may be responsible for autonomic findings in MS.

Decreased Neurofilament L Chain Levels in Cerebrospinal Fluid and Tolerogenic Plasmacytoid Dendritic Cells in Natalizumab-Treated Multiple Sclerosis Patients - Brief Research Report.

BACKGROUND: Neurofilament Light (NfL) chain levels in both cerebrospinal fluid (CSF) and serum have been correlated with the reduction of axonal damage in multiple sclerosis (MS) patients treated with Natalizumab (NTZ). However, little is known about the function of plasmacytoid cells in NTZ-treated MS patients. OBJECTIVE: To evaluate CSF NfL, serum levels of soluble-HLA-G (sHLA-G), and eventual tolerogenic behavior of plasmacytoid dendritic cells (pDCs) in MS patients during NTZ treatment. METHODS: CSF NfL and serum sHLA-G levels were measured using an ELISA assay, while pDCs (BDCA-2+) were accessed through flow cytometry analyses. RESULTS: CSF levels of NfL were significantly reduced during NTZ treatment, while the serum levels of sHLA-G were increased. Moreover, NTZ treatment enhanced tolerogenic (HLA-G+, CD274+, and HLA-DR+) molecules and migratory (CCR7+) functions of pDCs in the peripheral blood. CONCLUSION: These findings suggest that NTZ stimulates the production of molecules with immunoregulatory function such as HLA-G and CD274 programmed death-ligand 1 (PD-L1) which may contribute to the reduction of axonal damage represented by the decrease of NfL levels in patients with MS.

Altered cardiovascular reactivity to mental stress but not to cold pressure test in migraine.

OBJECTIVES: This study assessed cardiovascular reactivity to mental stress and cold pressure test in migraineurs and controls. It compared the cardiovascular reactivity between patients with migraine with aura and patients with migraine without aura. BACKGROUND: Several studies have assessed the autonomic nervous system functioning and cardiovascular responses to stressor stimuli in migraine. Cold pressure test and sustained attention tasks are distinct forms of induced stress. It is still unknown if patients with migraine have distinct patterns of response to sustained attention tasks and cold pressure test, since no previous studies have evaluated the cardiovascular responses to these 2 distinct types of stress in the same population of migraine patients. METHODS: Two distinct protocols were used to induce cardiovascular reactivity. Mental stress was induced by using a Stroop test card, a procedure involving the maintenance of the attention control. The other protocol was the cold pressure test. The blood pressure and heart rate were digitally recorded in rest and test phases. The mean elevation and the variance of blood pressure and heart rate were compared between groups. RESULTS: Patients with migraine had higher rest systolic blood pressure and lower heart rate induced by mental stress than controls. There were no differences between migraineurs and controls with cold pressure test. There were no differences between migraineurs with and without aura. CONCLUSION: There was a significantly different pattern of cardiovascular reactivity between migraineurs and controls with mental stress but not with cold pressure test. Distinct central nervous system structures are involved in these 2 types of stress. A distinct pattern of activation of the prefrontal cortex-periaqueductal gray matter circuit in migraine may explain a singular autonomic reactivity to mental stress in this disease.

Disability as a determinant of fatigue in MS patients.

INTRODUCTION: Fatigue is one of the most frequent and disabling symptoms in multiple sclerosis (MS). Central, psychological, and peripheral factors may contribute to the occurrence of fatigue. OBJECTIVES: The current study aimed to evaluate potential fatigue determinants in patients with relapsing-remitting MS with a low functional impairment. METHODS: We compared inflammatory markers, respiratory pressures, disability, and quality of life in 39 relapsing-remitting MS patients with and without fatigue. RESULTS: Patients with relapsing-remitting MS with fatigue had higher Expanded Disability Status Scale scores (p = 0.002). We observed a significant association between the results of the Guy Neurological Disability Scale, the Functional Assessment of MS Quality of Life Rating Scale and the presence of fatigue (p < 0.05). CONCLUSIONS: The degree of functional impairment is a determinant for the presence of fatigue in MS patients, but respiratory function and inflammatory markers are not.

Involvement of the central nervous system in patients with dengue virus infection.

The findings of a neurological evaluation in 85 patients with confirmed, acute, dengue virus infection are described. Signs of central nervous system involvement were present in 18 patients (21.2%). The most frequent neurological symptom was mental confusion. The frequency of neurological involvement did not differ between patients with primary and secondary dengue infection, and the prevalence of central nervous system involvement in dengue fever and dengue hemorrhagic fever also did not differ significantly. The presence of CNS involvement did not influence the prognosis of dengue infection. Dengue viral CSF RNA was found in 7 of 13 patients submitted to a spinal tap, the CSF viral load being less than 1000 copies/ml. PCR was negative in serum samples obtained from three patients on the same day as the CSF samples, suggesting that the dengue virus actively enters the CNS and that the presence of the virus in the CNS does not result from passive crossing of the blood-brain barrier.

Sensitivity and specificity of three ELISA-based assays for discriminating primary from secondary acute dengue virus infection.

BACKGROUND: Discrimination between primary and secondary dengue virus infection traditionally has been performed using the hemagglutination inhibition (HI) test. However, this test has practical limitations and disadvantages. OBJECTIVE: To evaluate the ability of three ELISA-based methods (IgG avidity test, IgM/IgG ratio and IgG titer) to discriminate primary from secondary dengue infection. STUDY DESIGN: Serum samples from convalescent-phase patients with confirmed acute, primary (n=46) or secondary (n=33) dengue virus infection were tested using three ELISA-based methods. A ROC curve was employed to establish the cut-off points and to evaluate the ability of the three methods to distinguish between acute, primary and secondary dengue virus infection. RESULTS: All three assays exhibited sensitivity and negative predictive values of 100% for defining secondary infection. The specificity and positive predictive values were respectively 97.8% and 93.7% for the IgG avidity test, 95.7% and 88.2% for the IgM/IgG ratio assays, and 97.8% and 93.7% for the IgG titer assay. CONCLUSION: All three ELISA-based assays proved reliable tools for discriminating between acute, primary and secondary dengue virus infection when using serum samples from convalescent-phase patients.

Prevalence and impact of headache and migraine among Pomeranians in Espirito Santo, Brazil.

This is the first study to assess the prevalence of headache and migraine among Pomeranian descendents in Brazil. A high prevalence of headache in the last 6 months was found (53.2%). Most headache sufferers were diagnosed as having migraine (55%). More women reported to have headache than men (65% and 33.8%, respectively). Migraine was the most common headache found among women (62.2%). Among men migraine was responsible for only 37.8% of the cases of headache. A high impact of headache was found, especially among migraineurs. Most of the headache sufferers declared to seek medical assistance for headache (67%) and most of them used to take common analgesics for headache relief. None of them was under prophylactic therapy.

Serum levels of adiponectin, CCL3/MIP-1α, and CCL5/RANTES discriminate migraine from tension-type headache patients.

OBJECTIVES: Inflammatory molecules and neurotrophic factors are implicated in pain modulation; however, their role in primary headaches is not yet clear. The aim of this study was to compare the levels of serum biomarkers in migraine and tension-type headache. METHODS: This was a cross-sectional study. We measured serum levels of adiponectin, chemokines, and neurotrophic factors in patients with migraine and tension-type headache. Depression and anxiety symptoms, headache impact and frequency, and allodynia were recorded. RESULTS: We included sixty-eight patients with migraine and forty-eight with tension-type headache. Cutaneous allodynia (p = 0.035), CCL3/MIP-1α (p = 0.041), CCL5/RANTES (p = 0.013), and ADP (p = 0.017) were significantly higher in migraine than in tension-type headache. The differences occurred independently of anxiety and depressive symptoms, frequency and impact of headache, and the presence of pain. CONCLUSIONS: This study showed higher CCL3/MIP-1α, CCL5/RANTES, and ADP levels in migraine in comparison with tension-type headache. Our findings suggest distinctive roles of these molecules in the pathophysiology of these primary headaches.

Performance of four ischemic stroke prognostic scores in a Brazilian population.

OBJECTIVE: Ischemic stroke (IS) prognostic scales may help clinicians in their clinical decisions. This study aimed to assess the performance of four IS prognostic scales in a Brazilian population. METHOD: We evaluated data of IS patients admitted at Hospital Paulistano, a Joint Commission International certified primary stroke center. In-hospital mortality and modified Rankin score at discharge were defined as the outcome measures. The performance of National Institutes of Health Stroke Scale (NIHSS), Stroke Prognostication Using Age and NIHSS (SPAN-100), Acute Stroke Registry and Analysis of Lausanne (ASTRAL), and Totaled Health Risks in Vascular Events (THRIVE) were compared. RESULTS: Two hundred six patients with a mean ± SD age of 67.58 ± 15.5 years, being 55.3% male, were included. The four scales were significantly and independently associated functional outcome. Only THRIVE was associated with in-hospital mortality. With area under the curve THRIVE and NIHSS were the scales with better performance for functional outcome and THRIVE had the best performance for mortality. CONCLUSION: THRIVE showed the best performance among the four scales, being the only associated with in-hospital mortality.

Reduced serum levels of adiponectin in tension-type headache.

BACKGROUND AND OBJECTIVES: Inflammatory mediators have been studied in tension type headache (TTH) pathophysiology; however, their role is not yet well established. The aim of the present study was to investigate adiponectin (ADP) and its association with clinical parameters and psychiatric comorbidities in TTH patients. METHODS: This was a cross sectional study including TTH patients and controls. Beck Depression (BDI) and Anxiety (BAI) Inventories, and Headache Impact Test (HIT-6) were recorded. Serum levels of ADP were measured by ELISA. RESULTS: Forty-eight TTH patients and forty-eight controls without headache were enrolled in the study. ADP levels were significantly lower among patients with TTH [31.1 (20.4-69.20) versus 37.8 (24.9-71.4) ng/mL (P=0.008)]. ADP levels were not influenced by BDI and BAI scores, body mass index (BMI), or HIT-6. CONCLUSION: ADP levels were reduced in TTH, independently of psychiatric comorbidities, BMI, and headache impact.

Neurotrophic factors in tension-type headache.

Neurotrophic factors (NF) are involved in pain regulation and a few studies have suggested that they may play a pathophysiological role in primary headaches. The aim of this study was to investigate NF levels in patients with tension type headache (TTH). We carried out a cross sectional study including 48 TTH patients and 48 age and gender matched controls. Beck Depression and Anxiety Inventories, and Headache Impact Test were recorded. Serum levels of NF were determined by ELISA. There were not significant differences between NF levels between TTH patients and controls. Patients with chronic and episodic TTH had not significant differences in NF levels. The presence of headache at the time of evaluation did not significantly alter the levels of NF. Depression and anxiety scores as well as headache impact did not correlate with NF levels. Our study suggest that the serum levels of NF are not altered in TTH.

Quantitative and qualitative evaluation of IgG synthesis in 8,947 cerebrospinal fluid samples / Avaliação quantitativa e qualitativa da síntese de IgG em 8.947 amostras de líquido cefalorraquidiano

ABSTRACT Introduction: Increased intrathecal immunoglobulin class G (IgG) synthesis can be found in several neuroinflammatory diseases. Objective: The aim of this study was to analyze quantitative and qualitative methods of intrathecal immunoproduction evaluation. Methods: We retrospectively assessed data from cerebrospinal fluid (CSF) and serum samples sent to Senne Liquor Diagnóstico from 2001 to 2017. Cytological, biochemical, and immunological data were compared between cases with and without oligoclonal bands (OCBs). Comparisons between samples with OCBs (OCB+) and without them (OCB-) were carried out, and the ability to predict the presence of OCBs was assessed with ROC analysis. Results: We included 8,947 samples (2,599 OCB+ samples and 6,348 OCB- samples). CSF lymphocytes and monocytes were significantly associated with the presence of OCB (p < 0.001). All the inflammatory parameters were significantly associated with OCB, and the methods with the highest predictive ability for OCB were IgG index and Reiber diagram [area under the receiver operating characteristic (AUROC) curve = 0.881 and 0.863, respectively]. A small percentage of cases without OCB had high IgG index (9.56%) or Reiber diagram, showing increased IgG production (4.6%). Conclusion: We showed a strong association between OCB and other CSF inflammatory parameters. The presence of cases with increased quantitative CSF IgG synthesis without OCB suggests that both quantitative and qualitative methods should be performed in the evaluation of neuroinflammatory processes.

RESUMEN Introducción: El incremento de la síntesis intratecal de inmunoglobulina G (IgG) puede ser encontrado en diferentes enfermedades neuroinflamatorias. Objetivo: Analizar retrospectivamente diferentes métodos de evaluación de la producción intratecal. Métodos: Se examinaron datos del líquido cefalorraquídeo (LCR) y suero enviados para el Senne Liquor Diagnóstico entre 2001 y 2017. Se compararon datos de citología, bioquímica e inmunología entre muestras con y sin bandas oligoclonales (BOC). Se hicieron comparaciones de los parámetros del LCR entre muestras con (BOC+) y sin BOC (BOC-), y la habilidad para predecir la presencia de BOCs fue evaluada mediante curvas ROC. Resultados: Se incluyeron 8.947 muestras, con 2.599 BOC+ y 6.348 BOC-. Recuentos de linfocitos y monocitos fueron significativamente asociados a la presencia de BOC (p < 0,001). Todos los métodos de evaluación de IgG fueron significativamente asociados a BOC+; aquellos con mayor asociación fueron el índice de IgG y el Reiber (área bajo la curva ROC = 0,881 y 0,863), respectivamente. Entre los casos BOC-, el índice de IgG fue alto en 9,56% y el Reiber demostró incremento de producción en 4,6%. Conclusión: Hubo fuerte asociación entre BOC y otros parámetros neuroinflamatorios del LCR. La existencia de casos BOC- con incremento de producción de IgG mediante métodos cuantitativos sugiere que tanto métodos cualitativos como cuantitativos deben ser usados en la evaluación de procesos neuroinflamatorios.

RESUMO Introdução: O aumento da síntese intratecal de imunoglobulina da classe G (IgG) pode ser encontrado em diferentes doenças neuroinflamatórias. Objetivo: Avaliar retrospectivamente diferentes métodos de avaliação da imunoprodução intratecal. Métodos: Dados de líquido cefalorraquidiano (LCR) e soro enviados para o Senne Liquor Diagnóstico entre 2001 e 2017 foram avaliados. Dados de citologia, bioquímica e imunologia foram comparados entre amostras com e sem bandas oligoclonais (BOCs). Comparações dos parâmetros do LCR entre amostras com (BOC+) e sem BOCs (BOC-) foram realizadas, e a habilidade de predizer a presença de BOCs foi avaliada por meio de curvas ROC. Resultados: Foram incluídas 8.947 amostras, sendo 2.599 BOC+ e 6.348 BOC-. Contagens de linfócitos e monócitos foram significativamente associadas à presença de BOC (p < 0,001). Todos os métodos de avaliação da IgG foram significativamente associados a BOC+; os com maior associação foram o índice de IgG e o Reiber [área sob a curva receiver operating characteristic (AUROC) = 0,881 e 0,863, respectivamente]. Entre os casos BOC-, o índice de IgG foi elevado em 9,56%, e o Reiber mostrou aumento de produção de IgG em 4,6%. Conclusão: Houve forte associação entre BOC e outros parâmetros neuroinflamatórios do LCR. A existência de casos BOC- com aumento da produção de IgG por métodos quantitativos sugere que tanto métodos qualitativos quanto quantitativos devem ser utilizados na avaliação dos processos neuroinflamatórios.

Migraine is associated with altered levels of neurotrophins.

Neurotrophic factors have been implicated in hyperalgesia and peripheral levels of these molecules were altered in behavioral and neurological disorders. The objectives of this study were to assess neurotrophic factors levels in migraine patients in comparison with controls, and to investigate whether there was any association between them and clinical parameters. This was a cross-sectional study. We measured serum levels of neurotrophin family members - nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin 3 and 4/5 (NT3 and NT4/5) - and glial cell line-derived factor (GDNF) in patients suffering from migraine and matched controls. One hundred forty-one people were enrolled in this study, seventy-one were migraine patients and seventy were controls. Migraine patients showed more depressive and anxiety symptoms than control individuals as assessed, respectively, by the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory. Chronic and episodic migraine patients showed higher NT4/5 levels than control individuals (P=0.001). Patients with chronic migraine had lower levels of BDNF that were not influenced by the presence of depressive symptoms (P=0.02). This is the first report to evaluate NT3 and NT-4/5 levels in migraine patients. Our findings suggest a possible role of neurotrophic factors in migraine pathophysiology.

Recurrent neuromyelitis optica with diffuse central nervous system involvement: case report.

Several demyelinating disorders can affect children. The differential diagnosis between these diseases is usually an arduous task. Diagnostic criteria have been proposed for some of these disorders, however most of them have not yet been clinically and prospectively validated. Here we present a case of a ten year-old boy with recurrent bilateral optic neuritis and spinal cord involvement. Clinical and cerebrospinal fluid data have fulfilled diagnostic criteria for Devic's neuromyelitis optica (NMO). The differential diagnosis with multiple sclerosis (MS) has become troublesome since not only optic nerves and spinal cord were involved. In one of the relapses a left hemiparesis with facial involvement was registered. Magnetic resonance imaging was also compatible with MS. This case illustrates that CNS demyelinating disorders can fulfill diagnostic criteria for more than one demyelinating disease, making the clinical judgment an important tool in the management of these patients.

Disseminated cerebral thrombotic microangiopathy in a patient with adult's still disease.

OBJECTIVE: The aim of this report is to describe a fatal disseminated thrombotic micoangiopathy with renal, pancreatic, and cerebral involvement in a patient with recently diagnosed adult's Still disease (ASD). CASE REPORT: A previously healthy 15 year old girl was admitted to our hospital. According to the clinical and laboratory data the diagnosis of adult's still Disease was established. The treatment was begun and few days after an initial improvement a sudden neurologic deterioration with coma and seizures has occurred. Hours later the patient died. Clinical, laboratorial, and pathologic data will be presented. CONCLUSION: To our knowledge this is the second description of a fatal disseminated cerebral thrombotic microangiopathy in a patient with adult's Still disease, but with a much more fulminating evolution than previously reported. Some etiopathogenic mechanisms could be shared in these two disorders explaining this coexistence.

Increased serum levels of adiponectin in migraine.

BACKGROUND AND OBJECTIVES: Inflammatory mediators, including adipokines, have been studied in migraine pathophysiology; however, their role is not yet well established. The aim of the present study was to investigate adiponectin (ADP) and its association with clinical parameters and psychiatric comorbidities in migraine patients compared with controls. METHODS: This was a cross sectional study including migraine patients and controls. Beck depression and anxiety inventories, Headache impact test, and Allodynia symptom checklist were recorded. Adiponectin was measured by ELISA. RESULTS: Sixty-eight migraine patients and sixty-five controls without headache were included. The ADP levels were significantly higher among patients with migraine (43.6±11.8 versus 36.6±9.7 ng/mL, P<0.0001). Adiponectin levels were not correlated with depression and anxiety scores, as well as with migraine severity and allodynia scores. CONCLUSION: ADP levels were raised in migraine, independently of psychiatric comorbidities, migraine impact, and allodynia.

Alcohol use problems in migraine and tension-type headache.

OBJECTIVE: The aim of this study was to assess alcohol use problems in patients with migraine and tension-type headache. METHOD: We evaluated 81 patients with migraine and 62 patients with tension-type headache. The identification of alcohol consumption problems was carried out with Alcohol Use Disorders Identification Test (AUDIT). Alcohol use problem was defined as an AUDIT score of 8 or above. The headache impact was calculated with headache impact test (HIT-6). RESULTS: The proportions of alcohol use problem among patients with migraine and tension-type headache were 5.2% and 16.1%, respectively (P=0.044). The headache impact was significantly higher with migraine than with tension-type headache (P<0.0001). There was an inverse correlation between headache impact and AUDIT (P=0.043). CONCLUSIONS: Our results suggest that migraine patients are less prone to alcohol use problems than tension-type headache patients. One of the possible reasons is that migraine is associated with greater impact than tension-type headache.