Altered gray matter volume and resting-state functional connectivity in migraine patients without aura / 中华神经科杂志

Objective:To investigate the underlying neuroimaging mechanism of migraine without aura (MwoA) by using methods of voxel-based morphometry (VBM) and resting-state functional connectivity (FC).Methods:Twenty-five MwoA patients admitted to Department of Neurology, the Second Affiliated Hospital of Xuzhou Medical University from September 2020 to June 2023 were recruited as MwoA group, and 22 volunteers were recruited as healthy control (HC) group. Demographic, clinical characteristics, scores of Hamilton Anxiety Scale (HAMA), Hamilton Depression Rating Scale (HAMD) and Montreal Cognitive Assessment (MoCA) of all subjects were collected; MwoA patients also received Migraine Disability Assessment Questionnaire, Headache Impact Test-6 and headache Visual Analogue Scale assessments. All subjects underwent high-resolution 3D-T 1 and resting-state functional magnetic resonance imaging scanning. The SPM12 software was used to compare the difference in gray matter volume (GMV) between the 2 groups by VBM method. The GRETNA software was adopted to calculate the whole brain FC with anatomical automatic labeling 90 as the regions of interest, and the difference in FC between the 2 groups was statistically analyzed by two-sample t-test. Pearson partial correlation was used to analyze the correlation between brain GMV and FC changes and clinical features and scale scores of MwoA patients. Results:There existed no statistically significant difference between the 2 groups in age, gender, education, scores of HAMA, HAMD and MoCA (all P>0.05). Migraine Disability Assessment Questionnaire, Headache Impact Test-6 and headache Visua Analogue Scale scores of MwoA patients were (8.86±4.55), (50.27±6.35) and (6.68±1.73). Compared with the HC group, GMV was significantly decreased in the right superior frontal gyrus (SFG), right cingulate gyrus (CG) and left thalamus in the MwoA group ( P<0.05, false discovery rate corrected). In addition, the MwoA group showed decreased FC between left thalamus and right cuneus, left lingual gyrus (LG) and bilateral precuneus; decreased FC between right thalamus and right cuneus, right LG and right precuneus; decreased FC between right cuneus and left precuneus and right SFG; decreased FC between left LG and bilateral precuneus, decreased FC between right LG and right precuneus and left SFG; decreased FC between left precuneus and bilateral SFG, and between right precuneus and right SFG (edge P<0.001, component P<0.05, network-based statistics correction, interation=2 000). In MwoA patients, the FC (z-value) between left thalamus and right cuneus was negatively correlated with the duration of disease ( r=-0.530, P=0.011). Conclusions:MwoA patients showed decreased GMV in right SFG, CG and left thalamus. In MwoA patients, FC between thalamus and visual network (VN) and default mode network (DMN) was significantly decreased, and FC among VN, DMN and executive control network was significantly decreased. These changes in brain structure and function may be an adaptive change in the central sensitivity and responsiveness to pain stimuli, and may be an important neuroimaging mechanism of MwoA.

MRI observation on abnormal brain activity in patients with migraine without aura / 中国医学影像技术

Objective To observe the abnormal brain activity in patients with migraine without aura(MwoA)with MRI.Methods Fifty MwoA patients(MwoA group)and 46 healthy volunteers(control group)were prospectively enrolled.Functional MRI(fMRI)was performed to observe the dynamic regional homogeneity(dReHo)of brain regions,then brain regions with differences of dReHo value between groups were extracted,and correlations with clinical scales were analyzed.Results Compared with control group,dReHo values of surrounding cortex of bilateral calcarine fissure and right middle occipital gyrus increased,of right middle temporal gyrus,right middle frontal gyrus and left cuneus decreased in MwoA group(GRF correction,voxel level all P＜0.005,cluster level all P＜0.05).The weight analysis showed that brain regions with top 3 absolute weight values were surrounding cortex of right calcarine fissure,left cuneus and right middle occipital gyrus.dReHo value of surrounding cortex of left calcarine fissure in MwoA patients was negative correlated with self-rating depression scale(SDS)(r=-0.28,P=0.04).Conclusion Abnormalities in the upward transmission pathway of visual information existed in MwoA patient,especially in surrounding cortex of right calcarine fissure,left cuneus and right middle occipital gyrus.

Migraine as a source of artistic inspiration / Enxaqueca como fonte de inspiração artística

This narrative review explores the intricate relationship between migraines and art, tracing historical examples and contemporary interpretations of how migraines, especially those with a visual aura, have influenced artists. Highlights how migraines may have shaped artistic inspiration, delving into notable, questionably migraine-infected figures such as Hildegard of Bingen, Giorgio de Chirico, Pablo Picasso, and Salvador Dali, examining how their experiences may have influenced their works. Furthermore, it addresses the emergence of 'migraine art' sponsored by the pharmaceutical industry, presenting the intersection between art, neuroscience, and public engagement. The diagnostic complexity and differentiation of migraines from epilepsy are also discussed, with a special focus on the symptoms of the visual aura and how this has been portrayed through various artistic representations, thus inviting further exploration of the relationship between neurological conditions and creative expression.

Esta revisão narrativa explora a intrincada relação entre enxaquecas e arte, traçando exemplos históricos e interpretações contemporâneas de como as enxaquecas, especialmente aquelas com aura visual, influenciaram os artistas. Destaca como as enxaquecas podem ter moldado a inspiração artística, investigando figuras notáveis e questionavelmente infectadas pela enxaqueca, como Hildegard de Bingen, Giorgio de Chirico, Pablo Picasso e Salvador Dali, examinando como suas experiências podem ter influenciado suas obras. Além disso, aborda o surgimento da "arte da enxaqueca" patrocinada pela indústria farmacêutica, apresentando a intersecção entre arte, neurociência e envolvimento público. A complexidade diagnóstica e a diferenciação entre enxaquecas e epilepsia também são discutidas, com especial foco nos sintomas da aura visual e como esta tem sido retratada através de diversas representações artísticas, convidando assim a uma maior exploração da relação entre condições neurológicas e expressão criativa.

Frecuencia de migraña y discapacidad generada en estudiantes de medicina humana de una universidad privada en Lima, Perú / Frequency of migraine and disability generated in medical students at a private university in Lima Peru

Objetivo : Estimar la frecuencia de migraña, y discapacidad generada en estudiantes de medicina de una universidad privada de Lima Metropolitana. Métodos : Estudio transversal en una muestra no probabilística por conveniencia, mediante la aplicación online del autocuestionario ALCOI-95, para evaluar la presencia de migraña, seguido por el cuestionario MIDAS para medir la discapacidad en los positivos al primer cuestionario. El rendimiento académico fue evaluado mediante el promedio ponderado de sus calificaciones. Resultados : Cuarenticinco (21,6%) de 208 estudiantes experimentaron migraña (12,5% con aura y 9,1% sin aura), 14 (33,3%) de los cuales mostraron discapacidad severa y 12 (28,6%) moderada. Los portadores de migraña con aura tuvieron una media menor del promedio ponderado acumulado de sus calificaciones, comparado con aquellos con migraña sin aura. Los factores independientemente asociados a la migraña fueron tener un miembro de la familia nuclear con migraña y problemas para mantener el sueño. Conclusión : Dos de cada 10 estudiantes presentaron migraña y 1/3 de los afectados experimentó discapacidad severa.

SUMMARY Objective: To estimate the frequency of migraine, associated factors and disability generated (including its relationship with academic performance) in medical students at a private university in Metropolitan Lima. Methods: Cross-sectional study in a non-probabilistic convenience sample using the online application of the ALCOI-95 self-questionnaire, to assess the presence of migraine, followed by the MIDAS questionnaire to measure disability in those positive to the first questionnaire. . Results: Fourty-five (21.6%) of 208 students experienced migraine (12.5% with aura and 9.1% without aura), 14 (33.3%) of whom showed severe, and 12 (28.6%) moderate disability. Migraine with aura carriers had a lower mean than the cumulative weighted average of their academic scores. Independent factors associated with migraine were to have a nuclear family member with migraine, and sleep-maintenance problems. Conclusion: Two out of 10 students had migraine, and one third of them had severe disability.

Differences of resting-state percent amplitude of fluctuations among migraineurs without aura with different efficacy of non-steroidal anti-inflammatory drugs / 中华行为医学与脑科学杂志

Objective:To explore the differences of resting-state spontaneous neural activity between migraine without aura (MwoA) patients with response or nonresponse to non-steroidal anti-inflammatory drugs (NSAIDs), and its correlation with migraine-related features.Methods:From February 2021 to April 2022, thirty MwoA patients with response to NSAIDs, 30 MwoA patients with nonresponse to NSAIDs, and 30 healthy controls were recruited in the Affiliated Jiangning Hospital of Nanjing Medical University.All subjects were scanned with a 3.0 T resting-state functional magnetic resonance imaging scanner.The percent amplitude of fluctuation (perAF) approach was used to calculate the differences of the resting state brain functional activities among the three groups (Bonferroni multiple comparison correction). SPSS 24.0 software and RESTplus software were used for statistical analysis.Analysis of variance was used for the perAF values of three groups.Correlation analysis was performed between perAF values of brain regions with significant differences and migraine-related features.Results:The brain areas showing significant differences of perAF among the three groups located in the left anterior cingulate cortex (ACC)( x, y, z = -6, 9, -3), left middle frontal gyrus (MFG)( x, y, z =-39, 48, 9) and left middle temporal gyrus (MTG)( x, y, z = -57, -30, -15)(all P<0.05, Bonferroni correction). Compared with nonresponse group, the perAF in response group showed significant decreased in the left ACC, MFG and MTG.There was positive correlation between the perAF of left ACC and disease duration ( r=0.506, P=0.007). Compared with healthy controls, the perAF of nonresponse group showed increased in the left ACC, which was negatively correlated with frequency ( r=-0.414, P=0.032). Conclusion:The neural activity of prefrontal cortex and ACC may be the neuropathological basis underlying response to NSAIDs in MwoA treatment.Moreover, the ACC has certain correlations with migraine-related characteristics, which may serve as a potential neuroimaging biomarker to evaluate the efficacy of NSAIDs.

Analysis of risk factors for secondary bilateral tonic-clonic seizures in patients with refractory temporal lobe epilepsy / 中风与神经疾病杂志

@#Objective To investigate the occurrence and risk factors of secondary bilateral tonic-clonic seizure (biTCS) in patients with refractory temporal lobe epilepsy (TLE). Methods Data on TLE patients who underwent resective surgical treatment at our epilepsy center,between January 2012 and December 2018,were collected consecutively,and their demographic and clinical characteristics were retrospectively analyzed to determine potential risk factors for biTCS using univariate analysis and multifactorial logistic regression analysis. Results A total of 397 patients were included in this study,and 70.0% (278/397) of them had biTCS.Univariate analysis showed that epilepsy duration and MRI were associated with the occurrence of biTCS in patients with TLE (P<0.05),and multifactorial logistic regression analysis showed that epilepsy duration (OR=1.13,95%CI 1.09-1.18,P<0.001) and aura (OR=0.51,95%CI 0.31-0.85,P=0.009) were independent risk factors for biTCS in refractory TLE patients.Receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) of the epilepsy duration for biTCS in TLE patients was 0.74 with a cut-off value of 9.5 years (sensitivity:66.5%,specificity:75.6%).Conclusion Most patients with refractory TLE develop biTCS during the course of the disease,and absence of aura and long epilepsy duration independently predict the occurrence of biTCS.

Transcranial alternating current stimulation in migraine without aura / 中华神经医学杂志

Objective:To investigate the efficacy and safety of transcranial alternating current stimulation (tACS) in treating migraine without aura.Methods:A prospective study was performed. From June 2021 to June 2022, 40 migraine without aura patients treated at Vertigo Center, Department of Neurology, Second Affiliated Hospital of Zhengzhou University were enrolled; they were randomly assigned to true group ( n=20) and pseudo group ( n=20); treatment was given for 4 consecutive weeks and follow-up was given for 4 weeks. Pseudo group did not receive current stimulation, while true group received stimulation by 77.5 Hz, 15 mA alternating current through electrodes placed on the forehead and bilateral mastoid (twice/d, 40 min each time, 5 d as a course, a total of 4 courses). Efficacies and adverse reactions were assessed before treatment, and at the end of treatment and follow-up, respectively. Results:Compared with pseudo group, the average monthly migraine days, visual analog scale (VAS) scores, Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Scale (HAMA) scores and Hamilton Depression Scale (HAMD) scores decreased statistically in true group ( P<0.05), and Migraine-specific Quality of Life Questionnaire (MSQ) scores increased statistically in true group ( P<0.05). In true group, compared with those before treatment, the average monthly migraine days, VAS scores, PSQI, HAMA scores and HAMD scores significantly decreased, and MSQ scores increased statistically at the end of treatment and follow-up ( P<0.05). During treatment, no adverse reactions such as seizures, hearing loss, scalp burns, dizziness, or tinnitus were noted in true group and pseudo group. Conclusion:Repeated tACS can obviously reduce frequency and degree of migraine, improve quality of life in migraine without aura patients; and good safety can be recorded.

Chronic headache and cannabinoids use: myths and truths / Cefaleia crônica e uso de canabinoides: mitos e verdades

ABSTRACT BACKGROUND AND OBJECTIVES: The use of cannabis for medical purposes is known since ancient times. The endocannabinoid system is present throughout central and peripheral nervous system and plays a role in many important regulatory physiological processes like immune function, synaptic plasticity, pain and regulation of stress and emotion, among others. Due to its wide distribution and according to researches, cannabis can be indicated for symptoms management in different disorders such as chronic pain, headache, epilepsy, anxiety and other psychiatric disorders. The primary cannabinoids studied to date include delta-9-tetrahydrocannabinol (THC), cannabinol (CBN), cannabigerol (CBG), and tetrahydrocannabivarin (THCV). The active ingredients in cannabis include flavonoids, terpenes, delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD) and they are able to act within the endocannabinoid system and decrease nociception and also the frequency of the symptoms. The purpose of the article is to document the validity of how medical cannabis can be utilized as an alternative therapy for chronic headache management and enlighten about false beliefs regarding its use. CONTENTS: Sixty-four relevant articles were selected after a thorough screening process using PubMed and Google Scholar databases. The following keywords were used: "Cannabis", "Medical Marijuana", "Headache", "Migraine", "Cannabis and Migraine", "Cannabis and Headache". This literature study demonstrates that medical cannabis use decreases migraine duration and frequency and headaches of unknown origin. CONCLUSION: Patients suffering from migraines and related conditions may benefit from medical cannabis therapy due to its convenience and efficacy.

RESUMO JUSTIFICATIVA E OBJETIVOS: O uso da cannabis medicinal é conhecido desde a antiguidade. O sistema endocanabinoide está distribuído no sistema nervoso central e periférico e atua como importante regulador em processos fisiológicos como função imune, plasticidade sináptica, regulação da dor e das emoções/estresse, entre outros. Devido à sua ampla distribuição e, de acordo com pesquisas, a cannabis pode ser indicada no manejo de sintomas em diferentes condições, como dor crônica, cefaleias, epilepsia, ansiedade e outras doenças psiquiátricas. Os canabinoides primários estudados são o 9-tetrahydrocannabinol (THC), cannabinol (CBN), canabigeral (CBG), e a tetrahidrocannabivarina (THCV). Os ingredientes ativos da cannabis incluem flavonoides, terpenos, delta-9- tetrahydrocannabinol (THC), canabidiol (CBD), e eles são capazes de agir dentro do sistema endocanabinoide e diminuir a nocicepção e a frequência dos sintomas. O objetivo deste estudo foi documentar a validade de como a cannabis medicinal pode ser utilizada como terapia alternativa para o manejo da cefaleia crônica, além de esclarecer sobre falsas crenças ligadas a seu uso. CONTEÚDO: Sessenta e quatro artigos foram selecionados por meio de pesquisa nas bases de dados Pubmed e Google Scholar. As seguintes palavras-chave foram usadas: "Cannabis", "Maconha Medicinal", "Cefaleia", "Enxaqueca", "Cannabis e Enxaqueca", "Cannabis e Cefaleia". A literatura mostra que o uso da cannabis medicinal reduz a duração e a frequência da enxaqueca e das cefaleias de origens não conhecidas. CONCLUSÃO: Pacientes sofrendo com enxaqueca e condições relacionadas podem se beneficiar da terapia com cannabis devido à sua conveniência e eficácia.

Migraine with aura and stroke - the role of warning signs in the context of secondary headaches: case report / Enxaqueca com aura e acidente vascular cerebral ­ o papel dos sinais de alerta no contexto das cefaleias secundárias: relato de caso

Introduction: Headache is a very common complaint in doctors' offices, with primary causes being the majority in relation to secondary ones. Despite this, the identification of secondary headaches is very relevant in clinical practice, since these can be a life-threatening condition, functionality or even a reversible cause. However, imaging screening for all individuals with headache is costly and unrewarding. Therefore, it is important to know the warning signs that, together with the clinical context, lead to a more precise indication of these exams and early and well-targeted therapeutic interventions. Clinical case: This is a 60-year-old man, previously dyslipidemic and smoker, with migraine with aura reported since childhood, who underwent treatment with sodium valproate, with headache attack suppression. About 4 months before admission, he presented with an alteration in the pain pattern, amaurosis fugax in the right eye, dizziness and mild paresis and hypoesthesia in the left side of the body, primarily treated by him as migraine crises, without improvement with the use of triptans. A new outpatient investigation was carried out, which showed multiple small infarcts in the right hemisphere secondary to atheromatous plaque in the right carotid bulb with an obstruction of approximately 85%. Diagnostic and therapeutic arteriography was performed, with stent implantation, uneventfully. Conclusion: The differential diagnosis between migraine with aura and a cerebrovascular event has already been widely reported in the literature and constitutes a pitfall in the routine of headaches, since a serious and potentially disabling condition can be overlooked. The joint evaluation of the alarm signs with the global context becomes an important tool in the propaedeutics of these patients, with knowledge of this casuistry being something relevant within clinical practice.

Introdução: A cefaleia é uma queixa muito comum nos consultórios médicos, sendo as causas primárias majoritárias em relação às secundárias. Apesar disso, a identificação de cefaleias secundárias é muito relevante na prática clínica, uma vez que estas podem ser uma condição potencialmente fatal, funcional ou mesmo uma causa reversível. No entanto, o rastreio imagiológico para todos os indivíduos com cefaleias é dispendioso e pouco recompensador. Portanto, é importante conhecer os sinais de alerta que, juntamente com o contexto clínico, levam a uma indicação mais precisa destes exames e a intervenções terapêuticas precoces e bem direcionadas. Caso clínico: Trata-se de um homem de 60 anos, previamente dislipidémico e fumador, com queixa de enxaqueca com aura desde a infância, que realizou tratamento com valproato de sódio, com supressão das crises de cefaleia. Cerca de 4 meses antes da internação apresentou alteração do padrão álgico, amaurose fugaz em olho direito, tontura e leve paresia e hipoestesia no lado esquerdo do corpo, tratada por ele primariamente como crises de enxaqueca, sem melhora com o uso de triptanos. Foi realizada nova investigação ambulatorial que evidenciou múltiplos pequenos infartos no hemisfério direito secundários a placa de ateroma no bulbo carotídeo direito com obstrução de aproximadamente 85%. Foi realizada arteriografia diagnóstica e terapêutica, com implante de stent, sem intercorrências. Conclusão: O diagnóstico diferencial entre enxaqueca com aura e evento cerebrovascular já foi amplamente relatado na literatura e constitui uma armadilha na rotina das cefaleias, uma vez que uma condição grave e potencialmente incapacitante pode ser negligenciada. A avaliação conjunta dos sinais de alarme com o contexto global torna-se uma ferramenta importante na propedêutica destes pacientes, sendo o conhecimento desta casuística algo relevante dentro da prática clínica.

Heat-sensitive moxibustion for migraine without aura: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical effect between heat-sensitive moxibustion and mild moxibustion for migraine without aura.@*METHODS@#A total of 54 patients with migraine without aura were randomized into an observation group (27 cases, 2 cases dropped off) and a control group (27 cases, 2 cases dropped off). The basic western medication treatment was adopted in the two groups. In the control group, mild moxibustion was applied at Shuaigu (GB 8), Fengchi (GB 20) and Yanglingquan (GB 34) on the affected side. In the observation group, the frequent acupoint areas of the affected side i.e. Shuaigu (GB 8), Fengchi (GB 20), Taiyang (EX-HN 5), Taichong (LR 3), Yanglingquan (GB 34) were determined, 3 acupoints with strong heat-sensitive sensation were selected each time and mild moxibustion was adopted. The treatment was given once a day, 5 times of treatment was as one course and 2 courses were required in the two groups. Before and after treatment, the scores of migraine symptom, visual analogue scale (VAS), migraine specific quality of life questionnaire (MSQ) were observed, and the clinical efficacy was evaluated after treatment in the two groups.@*RESULTS@#After treatment, the scores of migraine symptom and VAS were decreased compared with those before treatment (P<0.01), while the MSQ scores were increased compared with those before treatment (P<0.01) in the two groups. After treatment, the scores of migraine symptom and VAS in the observation group were lower than those in the control group (P<0.05), while the MSQ score in the observation group was higher than that in the control group (P<0.01). The total effective rate was 92.0% (23/25) in the observation group, which was superior to 72.0% (18/25) in the control group (P<0.05).@*CONCLUSION@#Both heat-sensitive moxibustion and mild moxibustion can effectively alleviate the clinical symptoms, improve the headache degree and life quality in patients with migraine without aura, the clinical efficacy of heat-sensitive moxibustion is superior to that of mild moxibustion.

Consensus of the Brazilian Headache Society (SBCe) for prophylactic treatment of episodic migraine: part II / Consenso da Sociedade Brasileira de Cefaleia (SBCe) para o tratamento profilático da migrânea episódica: parte II

Abstract Background Migraine affects 1 billion people worldwide and > 30 million Brazilians; besides, it is an underdiagnosed and undertreated disorder. Objective The need to disseminate knowledge about the prophylactic treatment of migraine is known, so the Brazilian Headache Society (SBCe, in the Portuguese acronym) appointed a committee of authors with the objective of establishing a consensus with recommendations on the prophylactic treatment of episodic migraine based on articles from the world literature as well as from personal experience. Methods Meetings were held entirely online, with the participation of 12 groups that reviewed and wrote about the pharmacological categories of drugs and, at the end, met to read and finish the document. The drug classes studied in part II of this Consensus were: antihypertensives, selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, calcium channel blockers, other drugs, and rational polytherapy. Results From this list of drugs, only candesartan has been established as effective in controlling episodic migraine. Flunarizine, venlafaxine, duloxetine, and pizotifen were defined as likely to be effective, while lisinopril, enalapril, escitalopram, fluvoxamine, quetiapine, atorvastatin, simvastatin, cyproheptadine, and melatonin were possibly effective in prophylaxis of the disease. Conclusions Despite an effort by the scientific community to find really effective drugs in the treatment of migraine, given the large number of drugs tested for this purpose, we still have few therapeutic options.

Resumo Antecedentes Migrânea afeta um bilhão de pessoas em todo o mundo e mais de 30 milhões de brasileiros; além disso, é um distúrbio subdiagnosticado e subtratado. Objetivo Sabe-se sobre a necessidade de difundir o conhecimento sobre o tratamento profilático da migrânea; por isso, a Sociedade Brasileira de Cefaleias (SBCe) nomeou um comitê de autores com o objetivo de estabelecer um consenso com recomendações sobre o tratamento profilático da migrânea episódica com base em artigos da literatura mundial, assim como da experiência pessoal. Métodos As reuniões foram realizadas inteiramente online, com a participação de 12 grupos que revisaram e escreveram sobre as categorias farmacológicas dos medicamentos e, ao final, reuniram-se para a leitura e conclusão do documento. As classes de medicamentos estudadas na parte II deste Consenso foram: anti-hipertensivos, inibidores seletivos de recaptação de serotonina, inibidores de recaptação de serotonina e noradrenalina, bloqueadores dos canais de cálcio, outros medicamentos e politerapia racional. Resultados Desta lista de medicamentos, apenas o candesartan foi estabelecido como eficaz no controle da migrânea episódica. Flunarizina, venlafaxina, duloxetina e pizotifeno foram definidos como provavelmente eficazes, enquanto lisinopril, enalapril, escitalopram, fluvoxamina, quetiapina, atorvastatina, sinvastatina, ciproheptadina e melatonina foram possivelmente eficazes na profilaxia da doença. Conclusões Apesar do esforço da comunidade científica em encontrarmedicamentos realmente eficazes no tratamento da migrânea, dado o grande número de medicamentos testados para este fim, ainda dispomos de poucas opções terapêuticas.

Headaches and obesity / Obesidade e cefaleia

ABSTRACT Obesity and headache disorders are two very common conditions in the general population that have been increasing in incidence over the last decades. Recent studies have shown a significant relationship between obesity and headaches, particularly migraine, with an important role in whether the disease is chronic. On the other hand, no such association was found with tension-type headaches. Studies showing an overlapping of hunger-control pathways and those involved in the pathophysiology of migraine may justify the close association between obesity and migraine. Moreover, a secondary headache for which obesity is a strong risk factor is idiopathic Intracranial Hypertension (pseudotumor cerebri), with several studies showing the impact of weight reduction/bariatric surgery in the treatment of the disease. In conclusion, since obesity is a modifiable risk factor, it is important for physicians treating patients with headaches, and particularly migraine, to be aware of the association between these two disorders.

RESUMO Obesidade e cefaleias são duas condições muito frequentes na população geral e que vem aumentando em incidência nas últimas décadas. Estudos recentes têm demonstrado uma significativa relação entre obesidade e cefaleia, particularmente na enxaqueca, com papel importante na cronificação da doença. Por outro lado, não se observa tal associação com cefaleia do tipo tensão. Trabalhos que mostram uma sobreposição das vias de controle da fome e daquelas envolvidas na fisiopatologia da enxaqueca podem justificar a íntima associação entre obesidade e enxaqueca. Além disso, uma cefaleia secundária para a qual a obesidade é um forte fator de risco é a Hipertensão Intracraniana Idiopática (pseudotumor cerebral), inclusive com diversos estudos mostrando o impacto da redução do peso/cirurgia bariátrica no tratamento da doença. Concluindo, visto que a obesidade é um fator de risco modificável, é importante para os médicos que tratam de pacientes com cefaleia e, particularmente, enxaqueca, estarem cientes da associação entre essas duas comorbidades.

The relation of cryptogenic ischemic stroke and migraine with aura patients with different right-to-left shunt volume by contrast enhanced transcranial Doppler / 中风与神经疾病杂志

@#Objective　To investigate the feature of the shunt volume of right-to-left shunt (RLS) in cryptogenic ischemic stroke (CIS) and migraine with aura (MA) and to analyze the different pathogenesis of CIS and MA with RLS.Methods　Forty-eight CIS patients and 42 MA patients from two case groups and 33 healthy volunteers from normal control group(NCG),using contrast enhanced transcranial doppler (cTCD) for diagnosing RLS and shunt volume grades,the positive rate of the three groups were analyzed.Results　In the case groups，the positive rate of RLS was MA 57.1% (24/42) and CIS 60.4%(29/48),of which large shunt accounted for MA 16.7% (7/42) and CIS 29.2%(14/48).In the NCG,the positive rate of RLS was 30.3% (10/33),of which large shunt accounted for 9.1% (3/33).Comparison of the three groups of the total positive rate，the total positive rate of two case groups were higher than NCG (MA vs NCG,P=0.02),(CIS vs NCG,P=0.008).Large shunt rate in CIS group was significantly higher than NCG (P=0.029).Conclusion　CIS and MA are significantly related to RLS.The large shunt rate of RLS in CIS patients was significantly higher than that in NCG.

Le savoir y faire de la gambiarra / O saber saber fazer da gambiarra / The applied know-how of the workaround

Pour discuter le thème plus général de l'invention qui se présente dans la clinique psychanalytique, cet article propose de penser la question des solutions de contournement comme des cas particuliers d'invention marqués par la dimension de la précarité. Cette précarité nous intéresse dans la mesure où elle nous permet d'accéder à une lecture non idéalisée de ce que Lacan formule comme invention sur le destin donné au symptôme dans le terme d'une psychanalyse, qui serait une manière de faire avec quelque chose pour laquelle il n'y a pas de programmation symbolique définie. Dans cette perspective, nous pensons que la pratique du psychanalyste actualise le bricolage de la solution de contournement comme une fuite vers la singularité inventive.

Visando discutir o tema mais geral da invenção que se apresenta no âmbito da clínica psicanalítica, este trabalho propõe pensar a questão da gambiarra como um caso particular de invenção marcada pela dimensão da precariedade. Essa precariedade interessa na medida em que nos permite alcançar uma leitura não idealizada do que Lacan formula como invenção acerca do destino dado ao sintoma no termo de uma psicanálise, que seria um modo de se haver com algo para o qual não se dispõe de uma programação simbólica definida. Nessa perspectiva, acreditamos que a prática do psicanalista atualiza a bricolagem da gambiarra como um escape para a singularidade inventiva.

In order to discuss the more general theme of the invention that presents itself in the scope of psychoanalytic clinic, this work propose to think about the issue of the workaround as a particular case of invention marked by the dimension of precariousness. This precariousness is of interest hereto the extent that it allows us to achieve a non-idealized reading of what Lacan formulates as an invention to describe the destiny given to the symptom at the end of a psychoanalysis, which would be a way of dealing with something for which there is no predefined symbolic setting. From this perspective, we believe that the psychoanalyst's practice updates the DIY aspect of the workaround as an escape towards the inventive singularity.

A case of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes mimicking migraine attacks with visual aura / 中国医师杂志

Objective:To study the case of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) which mimic migraine attacks with visual aura, to analyze the clinical features, and to recognize the nature of headache.Methods:The clinical features, image data and video electroencephalogram (EEG) of a suspected patient with MELAS were analyzed. Genomic DNA of mitochondria was extracted from blood and the next generation sequencing was performed to explore the mutation of genes about MELAS.Results:The patient was adolescent-onset, and presented with migraine-like attacks with visual aura, epileptic seizures, stroke-like episodes and hyperlactemia. Brain images suggested basal ganglia calcification, reversible left occipital cortex infarction and abnormal lactic acid peaks in both occipital cortex. Video EEG suggested abnormal adolescent EEG. Mitochondrial DNA sequencing showed that MT-TL1 gene had m. 3243A>G pathogenic mutation.Conclusions:There are a variety of clinical manifestations in MELAS, and migraine-like attacks with visual aura as initial symptoms may be manifestations of occipital lobe epilepsy. Clinicians should avoid confusing the diagnosis of migraine with visual aura, occipital epilepsy and MELAS, in order to make rational clinical decisions.

Investigation of serum vaspin, visfatin, chemerin and IL-18 levels in migraine patients / Investigação dos níveis séricos de vaspina, visfatina, quemerina e IL-18 em pacientes com migrânea

Abstract Background: Migraines are headaches caused by changes in the trigeminovascular metabolic pathway. Migraine headache attacks are associated with neurovascular inflammation, but their pathophysiological mechanisms have not been fully explained. Objective: To investigate the relationship between serum vaspin, visfatin, chemerin and interleukin-18 (IL-18) levels and the frequency of attacks in migraine headache. Methods: Three groups were established: migraine with aura (n = 50), migraine without aura (n = 50) and control group (n = 50). The migraine diagnosis was made in accordance with the International Classification of Headache Disorders-III beta diagnostic criteria. The analyses on serum vaspin, visfatin, chemerin and IL-18 levels were performed using the enzyme-linked immunosorbent assay method. Results: The serum vaspin, visfatin, chemerin and IL-18 levels were found to be significantly higher in the migraine patients than in the control group (p < 0.01). No statistically significant differences in serum vaspin, visfatin, chemerin and IL-18 levels were found among the migraine patients during attacks or in the interictal period (p>0.05). The serum visfatin and chemerin levels of the migraine patients were positively correlated with their serum IL-18 levels (p < 0.01), while their serum chemerin and visfatin levels were positively correlated with their serum vaspin levels (p < 0.05). Conclusions: This study showed that these biomarkers may be related to migraine pathogenesis. Nonetheless, we believe that more comprehensive studies are needed in order to further understand the role of vaspin, visfatin, chemerin and IL-18 levels in the pathophysiology of migraine headaches.

Resumo Introdução: A migrânea é causada por alterações nas vias metabólicas do sistema trigeminovascular. Crises de migrânea estão associadas à inflamação neurovascular, mas seus mecanismos patofisiológicos ainda não são totalmente explicados. Objetivo: Investigar a relação entre níveis séricos de vaspina, visfatina, quemerina e interleucina-18 (IL-18) e a frequência de crises de migrânea. Métodos: Três grupos foram formados: migrânea com aura (n = 50), migrânea sem aura (n = 50) e grupo controle (n = 50). A migrânea foi diagnosticada de acordo com os critérios da Classificação Internacional das Cefaleias (ICHD-III). As análises dos níveis séricos de vaspina, visfatina, quemerina e IL-18 foram realizadas utilizando-se o método imunoenzimático (ELISA). Resultados: Os níveis séricos de vaspina, visfatina, quemerina e interleucina-18 (IL-18) foram significativamente mais elevados em pacientes com migrânea do que no grupo controle (p < 0.01). Nenhuma diferença estatisticamente significativa foi observada nos níveis séricos de vaspina, visfatina, quemerina e interleucina-18 (IL-18) entre os pacientes com migrânea durante crises ou no período interictal (p>0,05). Os níveis séricos de visfatina e quemerina em pacientes com migrânea se correlacionaram positivamente com os níveis séricos de IL-18 (p < 0,01), ao passo que os níveis séricos de quemerina e visfatina se correlacionaram positivamente com os níveis séricos de vaspina (p < 0,05). Conclusões: Este estudo demonstrou que estes biomarcadores podem estar relacionados à patogênese da migrânea. Contudo, acreditamos que estudos mais abrangentes são necessários a fim de melhor compreendermos o papel dos níveis de vaspina, visfatina, quemerina e IL-18 na fisiopatologia da migrânea.

Terapias complementarias en migraña y variables relacionadas. Encuesta Europea / Complementary therapies in migraine and related variables. European Survey

Objetivo: valorar el uso de terapias alternativas no farmacológicas en migraña y variables relacionadas. La migraña afecta a una de cada diez personas en el mundo, con aumento creciente y mayor prevalencia entre mujeres de zonas urbanas. Aunque los tratamientos habituales son farmacológicos, se ha incrementado el uso de terapias alternativas no farmacológicas en migraña y variables relacionadas. Materiales y métodos: estudio observacional transversal mediante encuesta anónima vía web a 3.342 pacientes de países europeos sobre el uso de terapias alternativas para tratamiento de migraña. Variables de estudio: edad, género, país, tipo de localidad, nivel de estudios, ámbito rural o urbano y respuesta al tratamiento. Resultados: la utilización de terapias alternativas en migraña es un fenómeno creciente, con mayor uso en pacientes entre 41-60 años y estudios superiores. Conclusiones: en migraña se observan diferencias por edad, género, nivel cultural y país de procedencia. El uso de la medicina complementaria como alternativa terapéutica en la migraña es poco habitual y se debería indagar con mayor profundidad estableciendo relaciones que permitan apoyar al paciente afectado y priorizar las de mayor evidencia científica..(Au)

Objective: to evaluate the use of alternative non-pharmacological therapies in migraine and related variables. Migraine affects one in ten people worldwide, with a growing increase and a higher prevalence among women in urban areas. Although the usual treatments are pharmacological, the use of alternative techniques is increasing. Materials and methods: cross-sectional observational study by anonymous web survey of 3,342 patients from European countries on the use of alternative therapies. Study variables: age, gender, country, type of locality, educational level, rural or urban setting and treatment response. Results: the use of alternative therapies in migraine treatment is a growing phenomenon, with greater use in patients between 41-60 years of age and higher education. Conclusions: in Migraine, differences are observed by age, gender, cultural level and country of origin. The use of complementary medicine as an therapeutic alternative in migraine is uncommon and should be investigated in greater depth, establishing relationships that allow supporting the affected patient and prioritizing, if possible, some over others with scientific evidence..(Au)

Analysis of clinical characteristics and surgical outcomes of temporal lobe epilepsy patients with different auras / 中风与神经疾病杂志

@#To compared the clinical characteristics and surgical outcomes of temporal lobe epilepsy （TLE） patients with different auras，so as to provide more theoretical reference for the clinical diagnosis and treatment of TLE. Methods We retrospectively analyzed the clinical data of 408 TLE patients who underwent surgical treatment. The auras were divided into mesial temporal auras，lateral temporal auras，extratemporal auras and unspecific auras，and the age at seizure onset，gender，febrile seizures （FS），MRI，distribution of interictal epileptiform discharges （IEDs），secondary general tonicclonic seizures （SGTCS），operation side and surgical outcomes were compared in patients with different auras. Results 60.8% （248/408） of the TLE patients had auras，of which 37.7% were medial temporal auras，7.6% were lateral temporal auras，4.7% were extratemporal auras and 10.8% were unspecific auras. There was no significant difference in age at onset，gender，febrile seizures，MRI，distribution of IEDs，SGTCS and operation side in patients with or without auras（all P>0.05）. However，among patients with auras，those with mesial temporal auras had higher odds of focal IEDs （57.1% vs. 43.6%，P=0.039），and those with extratemporal auras had higher odds of FS and left side surgery （52.1% vs. 21.8%，P=0.006 and 73.7% vs. 49.3%，P=0.041，respectively）. The mean postoperative follow-up was 41.5±22.9 months and 75.4% （254/337） of patients were seizure free. There was no statistical difference in surgical outcomes among patients with different type of auras or no auras（P=0.483）.Conclusion The clinical characteristics including FS，lateralization of epileptogenic focus and distribution of IEDs in TLE patients with different type of auras had certain differences.However，there was no difference in surgical outcomes among TLE patients with no aura or different type of auras.

Relationship Between Gastrointestinal Diseases and Migraine Without Aura: A Cross-sectional Study / 胃肠病学

Background: Previous studies have found that patients with gastrointestinal diseases have a higher incidence of headache, while migraine patients are often accompanied by gastrointestinal symptoms. Understanding the relationship between diseases can provide new ideas for the study of its mechanism. Aims: To explore the co-occurrence and related risk factors of gastroesophageal reflux disease (GERD), functional dyspepsia (FD), irritable bowel syndrome (IBS) and migraine without aura (MWoA). Methods: A total of 2 696 adult rural residents in Shaanxi Province were investigated by random stratified sampling. MWoA, GERD, FD and IBS were diagnosed based on ICHD-IIIβ, Montreal classification and Rome , respectively. The prevalence of the single disease and overlapping prevalence of MWoA were calculated. The prevalence rates of GERD, FD and IBS between MWoA group and non-MWoA group were compared, and the disease-related risk factors were analyzed. Results: In this study, a total of 2 423 valid questionnaires were collected. The prevalence rates of GERD, FD and IBS were 12.5%, 15.6% and 6.9%, respectively, and the prevalence rate of MWoA was 8.8%. The prevalence rates of GERD (30.5% vs. 10.7%), FD (37.1% vs. 13.5%) and IBS (27.2% vs. 4.9%) in MWoA group were all higher than those in non-MWoA group (P all < 0.001). Multivariate analysis showed that female, hypertension, chronic motor system diseases were positively correlated with GERD, FD, IBS and MWoA. Conclusions: There is a certain association between GERD, FD, IBS and MWoA.

Clinical study of high-frequency repetitive transcranial magnetic stimulation in treatment of migraine without aura / 中华神经医学杂志

Objective:To study the efficacy and safety of high-frequency repetitive transcranial magnetic stimulation (hrTMS) in migraine without aura.Methods:A prospective sutdy was conducted; 74 patients with migraine without aura had definite diagnosis in our hospital from September 2019 to November 2020 were chosen and divided into hrTMS treatment group ( n=39) and control group ( n=35) by random number method. Patients in the hrTMS treatment group were treated with hrTMS once per d; the stimulation frequency was 20 Hz, each stimulus consisted of 20 sequences, and the amount of stimulus was 500 pulses; the treatment lasted for 6 d was as a course of treatment, and the next course of treatment was conducted at an interval of 1 d; a total of 4 courses of treatment was given. Patients in the control group were treated with pseudo-stimulation; treatment frequency was the same as above. Patients in the 2 groups were given oral conventional migraine drug (celecoxib, 0.2 g per time) according to the demands for analgesia (visual analog scale [VAS] scores≥4). The evoked potential N100 amplitudes and therapeutic effects 1, 2, and 4 weeks after treatment were evaluated and compared between the 2 groups; the occurrence of adverse reactions was observed. Results:There were significant differences in VAS scores and N100 amplitudes at each time point before and after treatment in the hrTMS treatment group ( P<0.05); the VAS scores decreased with time, while the N100 amplitudes increased with time. At 2 and 4 weeks after treatment, patients in the hrTMS treatment group had significantly lower VAS scores and statistically higher N100 amplitudes than those in the control group ( P<0.05). As compared with that in hrTMS treatment group before treatment and that in the control group at the same time point, the average days of headache per month in the hrTMS treatment group 4 weeks after treatment was significantly decreased ( P<0.05). No epileptic seizure, hearing loss, scalp burn or other adverse reactions occurred in the 2 groups after treatment. After treatment, there was no statistical significance in the incidence of dizziness, head discomfort, tinnitus or other adverse reactions between the 2 groups ( P>0.05). Conclusion:Long course of hrTMS can effectively improve the pain degree of patients with migraine without aura, and reduce the number of headache attacks, without obvious side effects, which is worthy of clinical application.