What is migraine?
News from science
Triggers
Our opinion
Migraine diary
Links
Home (eng)
To Danish siteNews from science - consequences of migraine
Click on the topic you want to read:Workdays lost from migraine
Dr. Brian Schwartz from Johns Hopkins University, Baltimore, Maryland has found that indirect costs because of headache and migraine are much greater than the costs of diagnosis and treatment. 13,343 inhabitants of Baltimore were telephoned and asked about their headache and migraine. 9.4% reported that they stayed off work more often than ´seldom´ and 31% said that their application to their work was more than halved because of their headache or migraine.7,970 of the people questioned had had headache or migraine during the last year and had had 4.2 days off work on average. 30.1% of the women and 17.1% of the men reported 6 or more days off work per year.
Journal of Occupational and Environmental Health 1997, 39, 320-327.
Uploaded 03-03-2005
Stress lasts longer in migraineurs
A study to determine how migraineurs, people with tension headache and a control group reacted to stress showed that migraineurs took longer than the other groups before their physiological reactions were back to normal again.Each participant in the study had to give a short lecture in front of a video camera. During the lecture, a red lamp lit if the performance wasn´t going well, a green lamp if it was OK and a white lamp if it was very good. The people in the study were asked to improve their performance using the signals they got from the coloured lamps.
In reality the lamps lit up at random and independently of how well the participants were doing, so that the three groups could be compared. The migraineurs themselves thought that they had held poorer lectures than the other groups, if they had had negative feedback from the lamps, while the group with tension headache wasn´t disturbed by the lamps´ messages.
After the lectures, the migraineurs had increased pulse rates for longer than the two other groups. Thus, Dr. Jeffrey E. Holm from the University of North Dakota suggests that migraineurs´ heart rhythms are possibly different from other peoples´.
Headache 1997, 37, 221-227.
Uploaded 03-03-2005
Light sensitivity and aura
A study which measured sensitivity in migraineurs´ vision area in the brain showed that 11 migraineurs with aura were much more sensitive to stimulation of that area of the brain, even when they didn´t have migraine, than 11 equivalent people used as controls.Neurology 1998, 50, 1111-1114.
Uploaded 03-03-2005
Hemiplegic migraineurs shouldn´t go diving
Patients with hemiplegic migraine are advised not to go diving, because an attack resembles the kind of problems that occur when a diver gets the bends (when he or she rises too quickly up through the water). Divers with ordinary types of migraine have no more problems than other folk and don´t need to take any special precautions when diving. On the other hand, you need to be especially observant about the safety rules while diving if you get an attack while under the water, advises a medical team writing in the journal ´Headache´ in March 2001. Use of beta-blockers should be considered carefully if you dive, because they can cause asthma, and strong painkillers (opiates) are also not advised because they reduce exhalation of CO2. This can result in the diver lacking oxygen and being confused during dives of depths to 20 – 30 metres.W. P. Cheshire and M. C. Ott, 2001. Headache in divers. Headache 41, 235-247.
Uploaded 03-03-2005
Stress causes migraine or migraine casues stress?
A French study has shown that 141 migraineurs who had on average 3.4 attacks per month were more stressed than a control group who didn´t have migraine. The scientists concluded that migraine is caused by stress, but there was nothing in the study that documented that the opposite conclusion wasn´t just as valid, - that migraineurs are more stressed simply because they have migraine and therefore have less time and energy available than healthy people.C. Wacogne, J. P. Lacoste, E. Guillibert, F. C. Hugues og C. Le Jeunne, 2003. Stress, anxiety, depression and migraine. Cephalalgia 23, 451-455.
Uploaded 03-03-2005
Light - migrainerus react more strongly
10 migraineurs with aura, 10 without aura and 8 controls were subjected to electrical stimuli that revealed how much phosphene is found in their visual cortex. Phosphene is a chemical in the brain that is necessary for us to be able to interpret what we see.Migraineurs with aura had much more phosphene in their visual cortices than the controls and migraineurs without aura had in-between amounts. All measurements were made when the migraineurs weren´t experiencing a migraine attack.
The authors suggest that migraineurs with high amounts of phosphene in their visual cortex are more susceptible to light than healthy folk, but they cannot determine if it is migraine that gives the high phosphene levels or whether the existence of phosphene gives a tendency to have migraine (1). An equivalent study with 37 migraineurs and 33 healthy controls showed that there was no difference between migraineurs with and without aura. This study had carefully ensured that female migraineurs were in the middle of their menstrual cycle to avoid possible effects caused by differences in hormone levels (2).
(1) S.K. Aurora, K. M. A. Welch and F. Al-Sayed, 2003, The threshold for phosphenes is lower in migraine. Cephalalgia 23, 258-263.
(2) V. Bohotin, A. Fumal, M. Vanderheede, C. Bhotin and J. Schoenen, 2003. Excitability of visual V1-V2 and motor cortices to single transcraial magnetic stimuli in migraine: a reappraisal using a figure-of-eight coil. Cephalalgia 23, 264-270.
Uploaded 03-03-2005
Problems for migraineurs
Interviews with 24 migraineurs showed that the most important worries about the effect of migraine on daily life were 1) the effect on the family, 2) lack of understanding by others, 3) its effect on work, 4) how the doctor reacts to migraine and 5) medicine and its side-effects.C. Cottrell, S. Waller, K. Holroyd and F. O’Donnell, 2000. Problems and needs of migraine sufferers: a focus group study. Cephalalgia 20, 316.
Uploaded 03-03-2005
Blood flow in brain abnormal in migraineurs
42 migraine patients in Spain were studied to find out if the blood-flow in their brains was normal. Half of the chronic migraineurs had abnormal blood flows in parts of their brains, but only 13 % of migraineurs with acute attacks showed this effect.E. P. Calandre, D. Becerra, J. Bembibre and M. L. Arnedo, 2000. Regional cerebral blood flow abnormalities in patients with migraine. Cephalalgia 20, 317.
Uploaded 03-03-2005
The length of an attack
Swedish doctors rang 5400 telephone numbers and found 495 people who thought themselves that they they had migraine and who were willing to answer a questionnaire.The doctors discovered that women vomit more often during an attack than men do. People had typically beteween 4 and 30 attacks per year but only 9% of the migraineurs had more than 1 attack per week. All age groups (18 to 74) had about the same number of attacks though an unexpectadly large number of young migraineurs (ages 18 to 29) had more than one attack per week. Only 7% of the older migraineurs had as many attacks.
Attacks lasted from quite a short time (less than an hour) to more than 5 days. Half of the migraineurs had attacks that lasted between 4 and 12 hours. More women than men had long-lasting attacks.
Less than a half of the migraineurs felt that they weren´t affected by the attacks. 65% had stayed away from school or work for at least one day because of their migraine but only a few (11%) had stayed away more often than once a month or more. 78% thought that their migraine had a negative effect on their work. Nearly 1 in 3 thought that they lost income because of migraine.
M. Linde og C. Dahlöf, 2004. Attitudes and burden of diseas among self-considered migraineurs - a nation-wide population-based survey in Sweden. Cephalagia 24, 455 - 465.
Uploaded 26-05-2005
Production of Norepinephrine is reduced in migraineurs
The nervous systems of migraineurs appear to be a bit different from those of other folk. For example migraineur´s blood contains less norepinephrine that that of other people if they cool a hand in ice water. Migraineurs´ pupils are also more sensitive to norepinephrine than those of controls. Scientists think that migraineurs have less norepinephrine stored in their nerves because they produce less than non-migraineurs. This means, suggest the scientists, that the trigeminus nerves of migraineurs are easier to activate by external stimuli than those of non-migraineurs, so there is an expansion of the blood vessels in the outer part of the brain.S. J. Peroutka, 2004. Migraine: a chronic sympathetic nervous system disorder. Headache 44, 53 - 64.
Norepinephrine (also known as noradrenalin) is a hormone of the same type as adrenalin that is it is produced in the brain and also is a nerve transmitter (it allows electrical signals to pass between nerve cells). Norepinephrine functions in many ways, e.g. by compressing small blood vessels so that blood pressure increases.
Uploaded 26-05-2005
Ice-cream headache is common among young people
8359 youngsters on Taiwan aged between 13 and 15 were asked if they got pains in their heads after eating something cold. Nearly 41% of them had experienced this kind of headache. A few more girls than boys got ice-cream headache and the ones who also had migraine had a greater tendency to get ice-cream headache.Only about 5% of the youngsters got this kind of headache every time, or nearly every time they ate something cold. For most of them, their headache disappeared after a minute or two. Only 1% of the youngsters avoided eating icecream because of the pain.
J.-L. Fuh, S.-J. Wang, S.-R. Lu og K.-D. Juang, 2003. Ice-cream headache - a large survey of 8359 adolescents. Cephalalgia 23, 977-981.
Uploaded 26-05-2005
The length and severity of migraine with aura
A group of Danish scientists asked about the attacks of 362 migraine patients from families that contained several people with migraine. They discovered that there were large variations in the length of the attacks, what symptoms accompanied them and how the aura was experienced. The scientists think that migraineurs with aura who come from families containing other migraineurs with aura are generally more severely hit than migraineurs with aura who have no relatives that also suffer from the same disease. Nearly everyone had visual disturbances, but about ¨÷ had tactile disturbances and/or disturbances to speech now and again, and now and again they had attacks without experiencing pains in the head., i.e. they had aura but no migraine afterwards. The tactile disturbances affected most often the face or hands.Migraine attacks with aura lasted between half an hour and more than 3 days, but most attacks lasted between 4 and 24 hours.
Nearly all migraineurs with aura had visual disturbances, and around one in three also had changed skin sensitivity and/or speach problems. Sometimes they had attacks without having headache, that is aura but no headache. The tactile problems were most often in the face or hand.
Nearly all migraineurs with aura were sensitive to light while they had an attack, and nearly half of them vomited.
M. K. Eriksen, L. L. Thomsen, I. Andersen, F. Nazim og J. Olesen, 2004. Clinical characteristics of 362 patients with familial migraine with aura. Cephalalgia 24, 564-575.
31-05-2005
Children whose mothers are migraineurs are given adult responsibilities at an early age
Mothers who have migraine know it well - when we can´t do it ourselves, we ask our children to take over. It has now been documented that children who have a mother with migraine and a father who doesn´t, undertake ´adult responsibilities´ more than children with healthy mothers.Luckily no difference was found between mothers with and without migraine when it came to looking after their children, general empathy with them and tendencies to give them corporal punishment.
M. A. Fagan, 2003. Exploring the relationship between maternal migraine and child functioning. Headache 43, 1042-1048.
Uploaded 26-05-2005
Strokes, blood platelets and migraine
Women with migraine between the ages of 19 and 64 have about a 2.5 times greater risk of having a stroke than non-migraineurs (1). A possible explanation has now emerged. A team of German doctors studied 72 migraineurs attending a migraine clinic in Kiel and found that they had a greater aggregation between blood platelets and white blood cells between attacks, compared with 72 controls. This tendency was especially evident in migraineurs without aura (2).The greater tendency for platelets to aggregate to white blood cells can also be seen in patients who have had strokes and those who have had diseases involving inflammation (reaction of tissue to damage or the like).
(1) A. L. Nightingale and R. D. T. Farmer, 2004. Ischemic Stroke in Young Women: A Nested Case-Control Study Using the UK General Practice Research Database. Journal of the American Heart Association 35, 1574-1578.
(2) J. A. Zeller, K. Frahm, R. Baron, R. Stingele and G. Deuschl 2004. Platelet-leukocyte interaction and platelet activation in migraine: a link to ischemic stroke? J. Neurol. Neurosurg. Psychiatry 75, 984-987.
Uploaded 30-10-2005
Migraineurs have poorer sight
Aura gives disturbances of vision, so there is reason the find out if migraineurs with and without aura might have different sight compared with non-migraineurs. 25 migraineurs without aura, 28 migraineurs with aura and 24 controls (with the same distribution of ages in all the groups) had their sight tested. The migraineurs were selected from the ´middle group´, those that didn´t have migraine every day, and they didn´t take medicine on the days they were studied.On average, migraineurs´ sight was found to be less sensitive than non-migraineurs´. There was no difference between having and not having aura. On the other hand, the more migraine attacks a person had had during the previous twelve months, the greater was the tendency to have less sharp vision. In addition, some migraineurs had some areas in their visual field that were less sensitive, but there was no connection between having these and the number of attacks suffered.
The doctors considered that the reduced visual acuity was caused by alterations in the vision centre of the brain (that is found in the farthest back part of the brain) and not in the eye.
A. M. McKendrick and D. R. Badcock, 2004. An analysis of the factors associated with visual field deficits measured with flickering stimuli in-between migraine. Cephalalgia 24, 389-397.
Uploaded 30-10-2005
Migraineurs also have other symptoms
Some diseases have been reported one or more times in the scientific literature as occurring together with migraine; i.e. migraineurs have a slightly higher than normal risk than non-migraineurs of experiencing one or more of the following symptoms:
• Depression
• Anxiety
• Panicking anxiety
• Manic depression
• Epilepsy
• Tourette’s disease
• Raynaud’s disease
• Blood pressure (varying)
• Apoplexy, sub-clinical changes in the brain
• Bulging of the wall of the heart
• Snoring and sleep apnoea (disturbed breathing during sleep)
• Asthma and allergy
• Lupus disease
• Pains other than headache
It cannot be concluded that migraine causes these diseases nor that they cause migraine. All that we know is that more migraineurs than expected also have one or more of these diseases.
A. I. Scher, M. E. Bigal and R. B. Lipton, 2005.Comorbidity of migraine. Current Opinion in Neurology 18, 305–310.
Uploaded 04-09-2008
Brain damage four times more common in migraineurs
Results pulished in September 2004 of a meta-analysis (a collection of all research results on the subject) show that migraineurs have 3.9 times increased risk of having damage of the white tissue in the brain, compared with the population in general. Even young migraineurs have this increased risk even though they have no other disease that increases the risk of brain damage.R. H. Swartz and R. Z. Kern, 2004. Migraine Is Associated With Magnetic Resonance Imaging White Matter Abnormalities. A Meta-analysis. Arch Neurol. 61, 1366-1368.
Uploaded 30-10-2005
High blood pressure, narrowing of blood vessels and increased cholesterol in migraineurs
An American dabase containing information about the medicine (triptans and ergotamines) prescribed for 130,411 migraineurs and a corresponding number of non-migraineurs was consulted. It also contained information about whether they had had problems with heart or circulation during the period 1994-1999 and about their use of estrogens. Since every individual prescription was registered, the scientists could divide the migraineurs into groups depending on their use of medicines. The database also held information about people in it who had died.Migraineurs were found to have had a slightly greater number of blood clots in their hearts - especially the users of ergotamines and people who did not take triptans. Migraineurs with higher than normal blood pressure were clearly over-represented, regardless of the medicine they used. Migraineurs also had a tendency to have more cholesterol than normal. Contraceptive pills were used by more female migraineurs than expected, although not by users of ergotamines.
There was no difference between migraineurs´ and non-migraineurs´ mortality, but there was a 67% increased risk that a migraineur would have had a stroke with short- or long-term effects, e.g. paralysis. The scientists were surprised to see that there was an incresed probability that migraineurs would die while they were under the influence of ergotamine (current or recent use of the drug). There was also a small increased risk of death from cancer among ergotamine users. On the other hand, there were fewer deaths than expected from heart disease among ergotamine users. The greatest risk of stroke among ergotamine users was among those migraineurs who took the drug between 11 and 28 days in 6 months.
P. Velentgas, J. A. Cole, J. Mo, C. R. Sikes and A. M. Walker, 2004. Severe vascular events in migraine patients. Headache 44, 642-651.
The study was partly finansed by Pfizer Inc.
The Danish Migraine Association recommends that all migraineurs should keep a careful eye on their blood pressure. High blood pressure should not be combined with the use of triptans or ergotamines.
Uploaded 30-10-2005
Brain damages (small) because of migraine
305 migraineurs and 140 people without migraine were scanned to see if traces of damage could be found in the inner brain. None of the participants had had a stroke or any other form of brain damage that could be diagnosed externally.Migraineurs (both with and without aura) had a slightly greater tendency to have damage to the white brain tissue ( the inner part - the outer part is grey). Damage was found in 5.4% of migraineurs and in 0.7% of controls. Migraineurs with more than one attack per month had a greater umber of these small lesions than migraineurs who experienced les than one attack per month (1). Another study of possible brain damage in maigraineurs showed that blood streamed through the white brain tissue of migraineurs (with and without aura) less than it did through that of non-migraineurs, but the difference was so little that it had no expression in altered behaviour nor was it unpleasant for the migraineurs (2).
(1) M. C. Kruit, M. A. van Bucjem, P. A. M. Bakkers, J. T. N. Terwindt, M. D. Ferrari and L. J. Launer, 2004. Migraine as a risk factor for subclinical brain lesions. JAMA 291, 427-434.
(2) M. A. Rocca, B. Colombo, M. Inglese, M. Codella, G. Comi and M. Filippi, 2003. J. Neurol. Neurosurg. Psychiatry 74, 501-503.
Uploaded 30-10-2005
Aura doesn´t happen every time
Aura is a phenomenon for which we still do not have a full explanation. An American doctor asked 952 of his patients if they had aura and if they experienced aura with every attack. About 1 out of 3 migraine patients said that they had aura now and again.Every third ´aura-migraineur´ experiened an aura every fourth attack or even more rarely, while one in five had aura at every attack. On average, aura-migraineurs experienced an aura at every fifth attack.
Aura can consist of much more than just visual disturbances, but visual changes are by far the most common form of aura. Dizziness, loss of feeling, and difficulties in speaking were common effects, either on their own or together visual disturbances.
Pain in the head appeared suddenly on average after 10 minutes with visual disturbances in 2 out of 3 migraineurs. The remainders experienced aura that sometimies wasn´t followed by head pain.
The author also mentioned that individual patients can change from experiencing aura to having periods entrirely without aura.
I. Kelman, 2004. The aura: a tertiary care study of 952 migraine patients. Cephalalgia 24, 729-734.
Uploaded 30-10-2005
What happens in the body during a migraine attack?
During symptoms of aura, there is a fall in blood flow through the parts of the cerebral cortex where the aura symptoms are generated. If you have aura, some time after the symptoms of aura disappear and the headache has started, the blood flow becomes normal and sometimes increases a little before becoming normal. These changes in the blood flow through the brain are entirely independent of the headache. The flow of blood is normal during the whole of a migraine attack without aura.During a migraine headache, the large arteries in the brain together with the temporal lobe artery enlarge 9% on the side of the brain where the headache is felt compared to the pain-free side.
During migraine attacks both with and without aura, there is special activity in the brain stem. What this means has not yet been explained, but it may be some kind of ´migraine generator´.
During a migraine attack, there are increased concentrations of serotonin and calcitonin-gen-related peptide, CGRP, in the brain. Migraine patients are more sensitive to nitrogen oxide (NO) than healthy people. NO can trigger attacks in migraine patients. This makes it possible to study disease mechanisms in more detail.
From the Institute for Rationel Pharmaco-therapy, November 2004 http://www.irf.dk/dk/publikationer/rationel_farmakoterapi/maanedsblad/2004/migraene
Uploaded 06-04-2006
Warnings about migraine attacks
893 migraineurs attending a clinic in the USA were asked if they had any warnings (prodromes in doctorspeak) in the hours before they got a migraine attack. They answered a number of other questions at the same time.1 in 3 had warnings before their attacks, mostly tiredness, mood swings and digestion problems. The warnings appeared most commonly a couple of hours before the attack, but could appear up to 12 hours in advance. Migraineurs who had warnings were generally more conscious about what had triggered their attack (alcohol, hormones, light, hunger, perfume, stress and changes in the weather).
L. Kelman, 2004. The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs. Headache 44, 865-872.
Uploaded 06-04-2006
Viagra and similar preparations and migraine
Viagra is not the only preparation that triggers migraine in some migraineurs - other similar drugs that strengthen an erection have the same unpleasant side-effect. An expert recommends that men who have experienced migraine in the hours after using Viagra or equivalent drugs (like Levitra and Cialis) should have a triptan ready against migraine. There are as yet no medical studies of the effect of taking triptans before the potency pill if it triggers migraine.C. Kruuse, 2004. Expert commentary on Phosphodiesterase-5 inhibitors and migraine. Headache 44, 925-926.
Uploaded 06-04-2006
Preventing attacks is cheaper than treating them
It is expensive to take triptans - for both the migraineur and for the social welfare system that pays for the medicine.It has been calculated that in USA the expenses to a patient that began to take triptans during 1998 - 2001 was $560 during the first year and $871 during the following year.
Migraineurs who continued to take triptans used an average of $1505 per year for their triptans. Preventive treatment cost only $560.
No costs because of days off from sickness etc were included. All the numbers are total costs as if there were no subsidies for the medicine. L. R. Etemad, W. Yang, D. Globe, A. Barlev and K. A. Johnson, 2005. Costs and utilization of triptan users who receive drug prophylaxis for migraine versus triptan users who do not receive drug prophylaxis. J Manag Care Pharm. 11, 137-44.
Uploaded 06-04-2006
Allodynia is common among migraineurs with chronic migraine
Allodynia is the symptom of experiencing pain (or at least sensitivity) that is more painful or unpleasant than normal.15 women who had migraine more than 15 days per month and a corresponding control group were subjected to pain by being prodded by a small needle. The tests were carried out on the underside of the forearm, on the temple, on the shoulder muscle (the one that supports the shoulder blade) and on the calf. The same places were stimulated by a wad of cotton wool.
A significant difference was found between the migraineurs and the control group. The control group tolerated double the amount of strong pain as the migraineurs on all parts of the body. 10 of the 15 migraineurs were classified as having allodynia and 6 migraineurs found being touched by the cotton wool unpleasant.
Nine of the migraineurs took triptans, 4 used painkillers, 13 used preventive medicine. 13 had migraine induced by overuse of medicine.
Unfortunately, there was no information about any connection between the allodynia and medicine.
L. Cooke, M. Eliasziv and W. J. Becker, 2007. Cutaneous allodynia in transformed migraine patients. Headache 47, 531-539.
Uploaded 4-9-2008
Allodynia (painful hair) migraineurs react more to light than other migraineurs and healthy people
13 migraineurs with allodynia, 15 migraineurs without allodynia and 30 healthy people were subjected to blinking lights and flickering black-white patterns. The flashes caused everyone to blink and the flickering patterns generated patterns in the brain that could be measured.The migraineurs with allodynia blinked more than the others and the reacted more strongly to the flickering patterns.
The doctors concluded that migraineurs with allodynia had a stronger reaction in the brain stem's trigeminus nerve than migraineurs without allodynia and healthy people.
K. Shibata, K. Yamane and M. Iwara, 2006. Change of excitability in brainstem and cortical visual processing in migraine exhibiting allodynia. Headache 46, 1535 – 44.
Uploaded 4-9-2007
Migraineurs´ blood platelets and white blood cells clump more
A German study reported in Cephalalgia in 2005 has shown that blood platelets and white blood cells (leucocytes) have a greater tendency to form clumps in migraineurs without aura, but not in migraineurs with aura. The clumping was found in patients who had taken triptans within the previous 3 days (1). The scientists speculated whether there might be a connection between the triptans and the clumping.A new German study has shown that the blood platelets and white blood cells had clumped together in non-migraineurs 2 hours after they had inhaled nitric oxide (NO) (2). And yet another study, investigating what happens in muscles that are exerted to their utmost, has shown that blood platelets and white blood cells form clumps after very strenuous muscle activity (probably because NO is released when muscles are subjected to great exertion) (3).
So while we have to conclude that blood platelets and white blood cells probably form clumps after a migraine attack without aura, the effect is probably due to an increased amount of NO in the blood just before the attack.
(1) J. A. Zeller, V. Lindner, K. Frahm, R. Baron and G. Deuschl, 2005. Platelet activation and platelet-leucocyte interaction in patients with migraine: Subtype differences and influence of triptans. Cephalalgia 25, 536-541.
(2) A. Herr, S. Kirsch, J. Motsch, E. Martin and A. Gries, 2005 Effects of Inhaled Nitric Oxide (iNO) on Platelet-Leucocyte Interactions in Healthy Volunteers. American Society of Anestesiologists Annual Meeting Abstracts, Atlanta October 22-26, 2005.
(3) S. Pasupathy, K. M. Naseem and S. Homer-Vanniasinkam, 2005. Effects of warm-up on exercise capacity, platelet activation and platelet-leucocyte aggregation in patients with claudication. British Journal of Surgery, 92, 50-55.
Uploaded 21-10-2006
Half of American migraineurs have not visited a doctor
That is the conclusion of a study of 1000 people using the same insurance company. 75% answered a questionnaire that disclosed that more than 20% had migraine. Only half of these had been to a doctor and been diagnosed so they could be prescribed medicine. Over 50% of those who had not been to a doctor because of their migraine, were so badly affected that they could not cope with ordinary life.The scientists request that information should be made available to doctors and to the general public about migraine, so more people can be treated.
K. A. Kobak, D. J. Katzelnick, G. Sands, M. King, J. J. Greist and M. Dominski, 2005. Prevalence and burden of illness of migraine in managed care patients. J. Manag. Care Pharm. 11, 124-136.
Uploaded 21-10-2006
Where is the pain?
An American doctor asked 1283 migraine patients where they experienced pain during an attack.Most had pain around the eye or in the temple, but there were also many who experienced pain at the back of the head, in the neck and on top of the head.
About the same numbers have pain on the right and left sides, but fewer whose pain changes side. A few have pain on both sides.
L. Kelman, 2005. Migraine pain location: a tertiary care study of 1283 migraineurs. Headache 25, 1038-1047.
Uploaded 21-10-2006
When does migraine start?
Most attacks start in the morning – or perhaps more accurately, we experience the first pain in the morning. Nearly half of all attacks (3582 attacks in 1698 patients were investigated) began between 4 am and 10 am.Women experience most attacks on the first day of menstruation. The longer since the last menstruation, the less chance there is of having a migraine attack. Surprisingly enough, there is no increased chance of having a migraine attack around the time of ovulation. Around 1/3 of all attacks in women happen during the first 6 days after the start of menstruation. 1208 women who had a total of 1610 attacks took part in this survey.
A. W. Fox, 2005. Time-series data and the ´Migraine Generator´. Headache 45, 920-925.
Uploaded 21-10-2006
High blood pressure is common in migraineurs with medicine-induced migraine
1486 patients at an Italian headache clinic had their blood pressure measured. Among those who had medicine-induced migraine 61% had increased blood pressure, while 55% of people with chronic tension headache had high blood pressure. Among patients whose attacks were less regular, 23% of those without aura had high blood pressure and 17% of those with aura (1).About 20% of the Italian population have high blood pressure, comparable to what the scientists found for those with scattered attacks with or without aura (2). There is therefore good reason to have your blood pressure measured if you to use a lot of migraine medicine.
(1) Pietrini U, De Luca M, De Santis G. 2005. Hypertension in headache patients? A clinical study. Acta Neurol Scand. 112, 259-64.
(2) E. Ambrosioni, G. Leonetti, A. Pessina, A. Rappelli, B. Trimarco, A. Zanchetti, 2000. Patterns of hypertension management in Italy: results of a pharmacoepidemiological survey on antihypertensive therapy. Journal of Hypertension. 18, 1691-1699.
Uploaded 21-10-2006
Insulin activity (or resistance)
Reduced insulin activity (sometimes also known as insulin resistance) is found in, among others, overweight people and in a study where muscle cells were subjected to NO (nitric oxide, laughing gas). The scientists think that there is a connection between an inflammation of the tissues and reduced insulin activity. The body experiences large amounts of fat as ‘wrong’ and reacts in the same way as if it were irritated or hurt (1).The small amount of NO in the blood at the start of a migraine attack is also interpreted by the body as an inflammation (2).
(1) D. B. Savage, K. F. Petersen and G. I. Shulman, 2005. Mechanisms of Insulin Resistance in Humans and Possible Links With Inflammation. Hypertension 45, 828-833.
(2) H. Sugita, M. Fujimoto, T. Yasukawa, N. Shimizu, M. Sugita, S. Yasuhara, J. A. Jeevendra Martyn and M. Kaneki, 2005. Inducible Nitric-oxide Synthase and NO Donor Induce Insulin Receptor Substrate-1 Degradation in Skeletal Muscle Cells. The Journal of Biological Chemistry 280, 14203–14211.
Uploaded 21-10-2006
Migraineurs´ blood vessels in the brain lack a control function
22 migraineurs (both with and without aura) and 33 healthy people had their blood pressure measured as well as the amount of blood flowing through the medial cranial artery. These showed that migraineurs (with and without aura – there was no difference between the two groups) appear to lack a mechanism that regulates blood pressure in individual arteries in the brain. It takes some time for the blood pressure of non-migraineurs to change if the blood flow alters. Migraineurs lack this delay and it is the blood pressure alone that determines how much blood flows through the artery. The scientists express this by saying that migraineurs lack an ´autonomous filter´ that works by evening out the effects of variations in blood pressure. The scientists think that there is a connection between these results and migraineurs´ lack of ´gating´ – i.e. their inability to ignore sounds or sounds that repeat more than 5 times.M. Müller and M. Marziniak, 2005. The Linear Behavior of the System Middle Cerebral Artery Flow Velocity and Blood Pressure in Patients With Migraine. Lack of Autonomic Control? Stroke 36, 1886-1890.
Uploaded 21-10-2006
Migraineurs are less active
30 otherwise hale and hearty migraineurs with no overweight problems were compared with an equivalent control group to study if they break down glucose the same way. The amount of glucose in their blood was measured before and after they drank a glucose solution after fasting for 12 hours. The migraineurs had higher concentrations of glucose in their blood after 1½ hours and until the study stopped after 3 hours. The amount of insulin the migraineurs’ blood was similar to that of the control groups´, but two different measurements of the activity of the insulin were equivalent to those of overweight people.The scientists recommend that a diet with a low sugar content can reduce the number of migraine attacks and recommend that migraineurs should exercise as a prevention against vascular disease (e.g. strokes and blood clots). Migraineurs who develop type 2 diabetes have an increased number of migraine attacks.
I. Rainero, P. Limone, M. Ferrero, W. Valfrè, C. Pelisetto, E. Rubino, S. Gentile, R. Lo Guidice and L. Pinessi, 2005. Insulin sensitivity is impaired in patients with migraine. Cephalalgia 25, 593-597.
Uploaded 21-10-2006
Continuous (transformed) migraine gives increased sensitivity to pain
40 patients with episodic migraine (i.e. their attacks were clearly separated) and 41 with continuous migraine (with migraine nearly every day) were subjected to painful stimuli on the skin of their face, neck and arms. The pain resulted from both heat and cold (0 - 50°C) applied to both (left and right) sides of the body. They were also tested with ´needles´ that bent under a given pressure against the skin. The subjects were asked to say when they experienced pain. All subjects were studied both when they were experiencing severe migraine and when they were well.When they were not having an attack, the subjects with episodic migraine tolerated pain from heat, cold and pressure significantly better than patients with continuous migraine. When both groups were having an attack, there was no significant difference between their sensitivity to temperature, but the patients with continuous migraine were more sensitive to pressure than patients with episodic migraine.
M. B. Kitaj and M. Klink, 2005. Pain thresholds in daily transformed migraine versus episodic migraine headache patients. Headache 25, 992-998.
Uploaded 21-10-2006
Changes in migraine with time
Some of us think that migraine just goes on and on for endlessly many years. But the statistics show that many people stop having migraine, or at least feel better.In 1993 a team of French scientists sent a questionnaire to all 46 000 employees in the French national gas company. About half of them replied and of them about 2500 suffered from migraine. 10 years later the doctors tracked down as many as possible of those who had migraine in 1993 and asked them again about their migraine or headaches.
398 of the ordinary migraineurs (with or without aura) from 1993 were refound 10 years later. But in 2003, only 146 of them still had ordinary migraine, 142 of them said that their migraine was now ´atypical´ (what the doctors call ´migrainous disorder´) and 72 ´only´ had headache occasionally. 38 were completely headache free.
Among the 364 people who had atypical migraine in 1993, 51 had developed ordinary migraine (with or without aura) in 2003, 128 still had atypical migraine and 143 had headache. 42 were free of migraine. Among the 296 who had headache in 1993, 18 had developed ordinary migraine, 62 had developed atypical migraine and 39 were free of migraine.
In general, about 1/3 had the same kind of migraine after 10 years and about 1/3 no longer hade migraine. Maybe the results had something to do with the average age of the participants; it was 46 in 1993, so 56 in 2003. As expected, more women than men in the study and women with hormone-induced migraine had a reasonable chance of being free of migraine (or having fewer migraines) after menopause. There was also a large group that still had migraine that was just as bad after 10 years.
F. Nachit-Oiuekh, J. F. Dartigues, V. Chrysostome, P. Henry, C. Sourge and A. El Hasnaoui, 2005. Evolution of migraine after a 10-year follow-up. Headache 45, 1280-1287.
Uploaded 21-10-2006
Nociceptin content in the blood is lower in migraineurs
Nociceptin is a chemical that the body produces itself and that acts as a natural pain-killer. It is a peptide (consisting of two or more amino acids bound together by a special connection) and the chemical's effect has been known since the middle of the 1940s.18 migraineurs without aura were compared with 24 non-migraineurs. Blood samples were taken in the morning from everyone and the migraineurs were studied both on the days when they were suffering from an attack and those days where there had been at least 7 1/2 hours before an attack started or one had finished.
The migraineurs had always a lower amount of nociceptin in their blood and the content was much lower during an attack. The more attacks a migraineur had had during the previous month, the lower the amount of nociceptin in their blood, but there was no connection with the time since the last attack. The scientists do not know with certainty whether the migraineurs' lower amounts of nociceptin was due to the migraine attacks or whether the migraineurs were more sensitive to pain and so experienced migraine because they had less pain-killer in their blood.
C. Ertsey, M. Hantos, G. Bozsik and K. Tekes, 2005. Plasma nociceptin levels are reduced in migraine without aura. Cephalalgia 25, 261-266.
Uploaded 06-04-2006