Postpartum migraines: a long-term prospective study.

OBJECTIVE: There are many reports regarding the course of migraines during pregnancy. However, the prevalence and characteristics of migraines during the postpartum period have not been adequately investigated. We prospectively investigated the patients suffering from migraines over a long postpartum period in an obstetrics department in Japan. METHODS: We investigated the course of migraines experienced during the postpartum period by patients in a postnatal ward. The patients were surveyed during the first postpartum week and 1, 3, 6 and 12 months after delivery. The patients were provided a headache diary to assess medication use and migraine attack frequency, severity (the faces pain scale) and duration. RESULTS: The migraine remission rate was 63%, 83% and 85% during the first, second and third trimesters, respectively. No patient experienced a worsening of headaches during pregnancy. Headache recurrence during the first month after delivery was more frequent in the patients >30 years of age than in those ≤30 years of age (p<0.05). The percentage of women experiencing recurrence at 1, 3, 6 and 12 months after delivery was 63%, 75%, 78% (n=60) and 87.5% (n=40), respectively. In breastfeeding patients, the rates were 50%, 65.8%, 71.1% and 91.7% and in bottle feeding patients, the rates were 86.4%, 90.9%, 95.5% and 81.3%, respectively. CONCLUSION: We found that 85% of the patients with migraines experience remission during pregnancy and that more than 50% experience recurrence during the first month after delivery. Until six months after delivery, breastfeeding is associated with a lower recurrence rate than bottle feeding.

Evaluation of olfaction in patients with migraine using an odour stick identification test.

AIMS: Peculiar characteristics of migraine headaches include the arousal of olfaction during the attacks and osmophobia. We performed an olfactory test to evaluate the association between olfaction and migraines. METHODS: We evaluated olfactory dysfunction in 80 migraine patients (31 experienced migraines with aura (MWA), 49 migraine without aura (MWOA)) and 30 healthy controls. Participants were assessed for concurrent osmophobia. Olfaction was evaluated using an odour stick identification test (OSIT), in which participants were asked to identify various odours during a migraine-free period. The degree of offensiveness of each odour was also evaluated. RESULTS: Sixty-three percent of migraine patients were found to have concurrent osmophobia (MWA 71%; MWOA 57%). The percentages of migraine patients and controls who correctly identified test odours were 91% (92%, MWA; 89%, MWOA) and 92%, respectively. Perfume, rose and Japanese cypress odours were more offensive to migraine patients than to controls. All test odours were found to be more offensive to MWA than to MWOA patients. CONCLUSIONS: The OSIT showed certain odours to be highly offensive to migraine patients even when they were not experiencing migraine headaches. More attention should be paid to odours that are perceived to be offensive by migraine patients, particularly those with MWA.

Prevalence of typical migraine aura without headache in Japanese ophthalmology clinics.

The aim of this study was to investigate the prevalence and characteristics of typical aura without headache (TAWH) in Japan. We distributed a self-report questionnaire comprising seven items. Of 1914 cases, the number of patients who provided valid answers was 1063. They included 1063 out-patients with 81 of these patients positive in the ID migraine screener Japanese version. TAWH was diagnosed in 35 patients (3.2%), aged 23-87 years, and included 12 males and 23 females. The age of patients with TAWH showed a biphasic distribution (20-39 years and 60-69 years), similar to the age distribution of all patients. Migraine with aura was diagnosed in 67 patients (6.3%) and showed a monophasic age distribution (40-49 years). These data suggest that TAWH is not a rare headache type in clinics especially in a setting of general ophthalmology clinics, and some patients of migraine with aura may transform to TAWH with ageing.