Migrainous infarction: a Nordic multicenter study.

BACKGROUND AND PURPOSE: Migrainous infarction (MI), i.e., an ischemic stroke developing during an attack of migraine with aura is rare and the knowledge of its clinical characteristics is limited. Previous case series using the International Classification of Headache Disorders (ICHD) included <10 cases which make conclusions less valid. This study aimed to describe characteristics and outcome of MI in a larger sample. METHODS: We analyzed demographic data, risk factors, migraine medication, stroke localization, symptoms, and outcome in a sample of 33 patients with MI according to second edition of the ICHD criteria collected from seven Nordic headache clinics. RESULTS: Amongst 33 patients with MI, there were 20 (61%) women and 13 (39%) men with the median age for stroke of 39 (range 19-76) years. Traditional risk factors for stroke were rare compared with Scandinavian young ischemic stroke populations. During the acute phase, 12 (36%) patients used ergotamines or triptans. Stroke was located in the posterior circulation in 27 (82%) patients and cerebellum was involved in 7 (21%). Except in two patients with brainstem infarctions, the outcome was favorable with total recovery or limited residual symptoms. CONCLUSIONS: The prevalence of traditional risk factors was low and the infarctions were predominantly located in posterior circulation territory, supporting theories of migraine specific mechanisms. The outcome was in general favorable.

Increased baroreflex sensitivity and heart rate variability in migraine patients.

OBJECTIVES: We investigated whether spontaneous baroreflex sensitivity and heart rate variability (HRV) are different in migraine patients compared to healthy controls. MATERIAL AND METHODS: Sixteen female migraine patients without aura aged 18-30 years and 14 age-matched healthy female controls were included. Continuous finger blood pressure and ECG were measured supine during paced breathing in the laboratory. Continuous finger blood pressure was measured the following 24-h period. Spontaneous baroreflex sensitivity (time-domain cross correlation baroreflex sensitivity) as well as HRV parameters were calculated. RESULTS: Spontaneous baroreflex sensitivity measured in the 24-h period was increased in patients (20.6 ms/mmHg) compared to controls (15.7 ms/mmHg, P = 0.031). HRV parameters were increased during paced breathing in patients (P < 0.045). CONCLUSIONS: The results suggest that central hypersensitivity in migraine also includes cardiovascular reactivity and may be important for the understanding of the mechanisms for the effect of antihypertensive drugs for migraine prophylaxis.

High pulse pressure protects against headache: prospective and cross-sectional data (HUNT study).

BACKGROUND: Many antihypertensive drugs are also used as migraine prophylactics, but the relationship between blood pressure and headache is not been well understood. The objective of the present study was to explore the association between blood pressure and headache prevalence, and the effect of antihypertensive medication on this relationship, using both cross-sectional and prospective data from a large population. METHODS: We used data from two large epidemiologic studies, the Nord-Trøndelag Health Survey 1984-1986 (HUNT-1) and 1995-97 (HUNT-2), to evaluate the association between blood pressure (systolic, diastolic, mean arterial, and pulse pressure) and migraine and nonmigrainous headache. RESULTS: Increasing systolic blood pressure was associated with decreasing prevalence of having nonmigrainous headache or migraine. The most consistent and robust finding, however, was that increasing pulse pressure was linked to decreased prevalence of both nonmigrainous headache and migraine, evident for both sexes in the prospective and cross-sectional analyses. In subjects using antihypertensive medication, this finding was less clear. CONCLUSION: Both increased systolic blood pressure and pulse pressure are related to arterial stiffness and may decrease headache prevalence through modulation of the baroreflex arch, which in turn generates hypoalgesia. This is due to a phenomenon called hypertension-associated hypalgesia. Stimulation of the baroreflex arch in response to increased blood pressure is assumed to inhibit pain transmission at both spinal and supraspinal levels, possibly because of an interaction of the centers modulating nociception and cardiovascular reflexes in the brainstem.