What is the influence of high altitude on migraine?

Migraine associated with altitude: results from a population-based study in Nepal.

Linde M, Edvinsson L, Manandhar K, Risal A, Steiner TJ.

Eur J Neurol 2017; 24:1055-1061.

Abstract

BACKGROUND AND PURPOSE:

A 1988 pilot study in Peru suggested an association between migraine and chronic exposure to high altitude. This study provides epidemiological evidence corroborating this.

METHODS:

In a cross-sectional nationwide population-based study, a representative sample of Nepali-speaking adults were recruited through stratified multistage cluster sampling. They were visited at home by trained interviewers using a culturally adapted questionnaire. The altitude of dwelling of each participant was recorded.

RESULTS:

Of 2100 participants, over half [1100 (52.4%)] were resident above 1000 m and almost one quarter [470 (22.4%)] at ≥2000 m. Age- and gender-standardized migraine prevalence increased from 27.9% to 45.5% with altitude between 0 and 2499 m and thereafter decreased to 37.9% at ≥2500 m. The likelihood of having migraine was greater (odds ratio, 1.5-2.2; P ≤ 0.007) at all higher altitudes compared with <500 m. In addition, all symptom indices increased with altitude across the range <500 m to 2000-2499 m, i.e. median attack frequency from 1.3 to 3.0 days/month (P < 0.001), median duration from 9 to 24 h (P < 0.001) and pain intensity [the proportion reporting ‘bad pain’ (highest intensity)] from 35.5% to 56.9% (P = 0.011). Each of these showed a downward trend above 2500 m.

CONCLUSIONS:

Dwelling at high altitudes increases not only increase migraine prevalence but also the severity of its symptoms.

This reference contributes to the neurochecklist:

Migraine risk factors

Abstract link

By George Cruikshankhttp://metmuseum.org/art/collection/search/393320, Public Domain, Link
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How does body weight influence the risk of migraine?

Body composition status and the risk of migraine: a meta-analysis

Gelaye B, Sacco S, Brown WJ, Nitchie HL, Ornello R, Peterlin BL.

Neurology 2017; 88:1795-1804.

Abstract

OBJECTIVE:

To evaluate the association between migraine and body composition status as estimated based on body mass index and WHO physical status categories.

METHODS:

Systematic electronic database searches were conducted for relevant studies. Two independent reviewers performed data extraction and quality appraisal. Odds ratios (OR) and confidence intervals (CI) were pooled using a random effects model. Significant values, weighted effect sizes, and tests of homogeneity of variance were calculated.

RESULTS:

A total of 12 studies, encompassing data from 288,981 unique participants, were included. The age- and sex-adjusted pooled risk of migraine in those with obesity was increased by 27% compared with those of normal weight (odds ratio [OR] 1.27; 95% confidence interval [CI] 1.16-1.37, p < 0.001) and remained increased after multivariate adjustments. Although the age- and sex-adjusted pooled migraine risk was increased in overweight individuals (OR 1.08; 95% CI 1.04, 1.12, p < 0.001), significance was lost after multivariate adjustments. The age- and sex-adjusted pooled risk of migraine in underweight individuals was marginally increased by 13% compared with those of normal weight (OR 1.13; 95% CI 1.02, 1.24, p < 0.001) and remained increased after multivariate adjustments.

CONCLUSIONS:

The current body of evidence shows that the risk of migraine is increased in obese and underweight individuals. Studies are needed to confirm whether interventions that modify obesity status decrease the risk of migraine.

This reference is contributes to the neurochecklist:

Abstract link

Different Shades of Migraine. Tudor Barker on Flikr. https://www.flickr.com/photos/tudedude/4326739234

What is the effect of venous sinus stenting for IIH?

Dural venous sinus stenting for medically and surgically refractory idiopathic intracranial hypertension

Satti SR, Leishangthem L, Spiotta A, Chaudry MI.

Interv Neuroradiol 2017; 23:186-193.

Abstract

Idiopathic intracranial hypertension (IIH) is a syndrome defined by elevated intracranial hypertension without radiographic evidence of a mass lesion in the brain. Dural venous sinus stenosis has been increasingly recognized as a treatable cause, and dural venous sinus stenting (DVSS) is increasingly performed.

A 5 year single-center retrospective analysis of consecutive patients undergoing DVSS for medically refractory IIH.

There were 43 patients with a mean imaging follow-up of 6.5 months and a mean clinical follow-up period of 13.5 months. DVSS was performed as the first procedure for medically refractory IIH in 81.4% of patients, whereas 18.6% of patients included had previously had a surgical procedure (ventriculoperitoneal (VP) shunt or optic nerve sheath fenestration (ONSF)). Headache was present in all patients and after DVSS improved or remained stable in 69.2% and 30.8%, respectively. Visual acuity changes and visual field changes were present in 88.4% and 37.2% of patients, respectively. Visual field improved or remained unchanged in 92%, but worsened in 8% after stenting. There was a stent patency rate of 81.8%, with an 18.2% re-stenosis rate. Of the 43 procedures performed, there was a 100% technical success rate with zero major or minor complications.

Based on this single-center retrospective analysis, dural venous sinus stenting can be performed with high technical success and low complication rates. A majority of patients presented primarily with headache, and these patients had excellent symptom relief with DVSS alone. Patients presenting with visual symptoms had lower success rates, and this population, if stented, should be carefully followed for progression of symptoms.

This reference is cited in the neurochecklist:

Idiopathic intracranial hypertension (IIH): surgical treatment

Abstract link

Annotated Sagittal ATECO MR Venogram. Reigh LeBlanc on Flikr. Annotated Sagittal ATECO MR Venogram

Is migraine a risk factor for peri-operative stroke?

Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study

Timm FP, Houle TT, Grabitz SD, et al.

BMJ 2017; 356:i6635.

Abstract

OBJECTIVE:

To evaluate whether patients with migraine are at increased risk of perioperative ischemic stroke and whether this may lead to an increased hospital readmission rate.

MAIN OUTCOME MEASURES:

The primary outcome was perioperative ischemic stroke occurring within 30 days after surgery in patients with and without migraine and migraine aura. The secondary outcome was hospital readmission within 30 days of surgery. Exploratory outcomes included post-discharge stroke and strata of neuroanatomical stroke location.

RESULTS:

10 179 (8.2%) patients had any migraine diagnosis, of whom 1278 (12.6%) had migraine with aura and 8901 (87.4%) had migraine without aura. 771 (0.6%) perioperative ischemic strokes occurred within 30 days of surgery. Patients with migraine were at increased risk of perioperative ischemic stroke (adjusted odds ratio 1.75, 95% confidence interval 1.39 to 2.21) compared with patients without migraine. The risk was higher in patients with migraine with aura (adjusted odds ratio 2.61, 1.59 to 4.29) than in those with migraine without aura (1.62, 1.26 to 2.09). The predicted absolute risk is 2.4 (2.1 to 2.8) perioperative ischemic strokes for every 1000 surgical patients. This increases to 4.3 (3.2 to 5.3) for every 1000 patients with any migraine diagnosis, 3.9 (2.9 to 5.0) for migraine without aura, and 6.3 (3.2 to 9.5) for migraine with aura. : Patients with migraine had a higher rate of readmission to hospital within 30 days of discharge (adjusted odds ratio 1.31, 1.22 to 1.41).

CONCLUSIONS:

Surgical patients with a history of migraine are at increased risk of perioperative ischemic stroke and have an increased 30 day hospital readmission rate. Migraine should be considered in the risk assessment for perioperative ischemic stroke.

This reference is included in the neurochecklists:

Ischaemic stroke: non-genetic risk factors

&

Migraine and stroke

 

Abstract link

By see above – Album comique de pathologie pittoresque Paris : Tardieu, 1823 The National Library of Medicine, Public Domain, Link

Do oral contraceptives increase the risk of stroke in people with migraine?

Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke

Champaloux SW, Tepper NK, Monsour M, et al.

Am J Obstet Gynecol 2017; 216:489.e1-489.e7.

Abstract

BACKGROUND:

Migraine with aura and combined hormonal contraceptives are independently associated with an increased risk of ischemic stroke. However, little is known about whether there are any joint effects of migraine and hormonal contraceptives on risk of stroke.

OBJECTIVE:

We sought to estimate the incidence of stroke in women of reproductive age and examine the association among combined hormonal contraceptive use, migraine type (with or without aura), and ischemic stroke.

STUDY DESIGN:

This study used a nationwide health care claims database and employed a nested case-control study design. Females ages 15-49 years with first-ever stroke during 2006 through 2012 were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification inpatient services diagnosis codes. Four controls were matched to each case based on age. Migraine headache with and without aura was identified using inpatient or outpatient diagnosis codes. Current combined hormonal contraceptive use was identified using the National Drug Code from the pharmacy database. Conditional logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals of ischemic stroke by migraine type and combined hormonal contraceptive use.

RESULTS:

From 2006 through 2012, there were 25,887 ischemic strokes among females ages 15-49 years, for a cumulative incidence of 11 strokes/100,000 females. Compared to those with neither migraine nor combined hormonal contraceptive use, the odds ratio of ischemic stroke was highest among those with migraine with aura using combined hormonal contraceptives (odds ratio, 6.1; 95% confidence interval, 3.1-12.1); odds ratios were also elevated for migraine with aura without combined hormonal contraceptive use (odds ratio, 2.7; 95% confidence interval, 1.9-3.7), migraine without aura and combined hormonal contraceptive use (odds ratio, 1.8; 95% confidence interval, 1.1-2.9), and migraine without aura without combined hormonal contraceptive use (odds ratio, 2.2; 95% confidence interval, 1.9-2.7).

CONCLUSION:

The joint effect of combined hormonal contraceptives and migraine with aura was associated with a 6-fold increased risk of ischemic stroke compared with neither risk factor. Use of combined hormonal contraceptives did not substantially further increase risk of ischemic stroke among women with migraine without aura. Determining migraine type is critical in assessing safety of combined hormonal contraceptives among women with migraine.

This reference is included in the neurochecklist:

Migraine risk factors

Abstract link

By BetteDavisEyes at English Wikipedia – Transferred from en.wikipedia to Commons.; transfer was stated to be made by Tanvir., Public Domain, Link

What is the most sensitive MRI sign of IIH?

Transverse sinus stenosis is the most sensitive MR imaging correlate of idiopathic intracranial hypertension

Morris PP, Black DF, Port J, Campeau N.

Am J Neuroradiol 2017; 38:471-477.

Abstract

BACKGROUND AND PURPOSE:

Patients with idiopathic intracranial hypertension have transverse sinus stenosis on gadolinium-bolused MRV, but other MR imaging signs are less consistently seen. Our aim was to demonstrate that transverse sinus stenosis could be identified on conventional MR imaging, and this identification would allow improved diagnostic sensitivity to this condition.

MATERIALS AND METHODS:

MR imaging and MRV images from 63 patients with idiopathic intracranial hypertension and 96 controls were reviewed by using 3 independent procedures. MRV images were graded for the presence and degree of stenosis of the transverse sinus. Postgadolinium coronal T1-weighted sequences were evaluated independent of MRV. The dimensions of the proximal and distal transverse sinus were measured from the MRV examinations, and the cross-sectional area of the transverse sinus was calculated. Correlation among the 3 modes of evaluation of the transverse sinus was conducted by using Wilcoxon/Kruskal-Wallis, Pearson, and Spearman ρ nonparametric statistical techniques.

RESULTS:

Transverse sinus stenosis was identified bilaterally on MRV in 94% of patients with idiopathic intracranial hypertension and in 3% of controls. On coronal T1 postgadolinium MR images, transverse sinus stenosis was identified in 83% of patients with idiopathic intracranial hypertension and 7% of controls. Previously described MR imaging signs of intracranial hypertension were identified in 8%-61% of patients with idiopathic intracranial hypertension. Correlation among the 3 modes of evaluation was highly significant (P < .0001).

CONCLUSIONS:

Even without the assistance of an MRV sequence, neuroradiologists can validly identify bilateral transverse sinus stenosis in patients with intracranial hypertension more reliably than other previously described MR imaging findings in this condition. We conclude that transverse sinus stenosis is the most useful and sensitive imaging indicator of this disease state.

This reference is included in the neurochecklist:

Idiopathic intracranial hypertension (IIH): investigations

Abstract link

By Jonathan Trobe, M.D. – University of Michigan Kellogg Eye Center – The Eyes Have It, CC BY 3.0, Link

What is the relationship between cervical artery dissection and migraine?

Association between migraine and cervical artery dissection: the Italian project on stroke in young adults.

De Giuli V, Grassi M, Lodigiani C, et al

JAMA Neurol 2017; 74:512-518.

Abstract

OBJECTIVE:

To investigate whether a history of migraine and its subtypes is associated with the occurrence of CEAD.

DESIGN, SETTING, AND PARTICIPANTS:

A prospective cohort study of consecutive patients aged 18 to 45 years with first-ever acute ischemic stroke enrolled in the multicenter Italian Project on Stroke in Young Adults was conducted between January 1, 2000, and June 30, 2015. In a case-control design, the study assessed whether the frequency of migraine and its subtypes (presence or absence of an aura) differs between patients whose IS was due to CEAD (CEAD IS) and those whose IS was due to a cause other than CEAD (non-CEAD IS) and compared the characteristics of patients with CEAD IS with and without migraine.

RESULTS:

Of the 2485 patients (mean [SD] age, 36.8 [7.1] years; women, 1163 [46.8%]) included in the registry, 334 (13.4%) had CEAD IS and 2151 (86.6%) had non-CEAD IS. Migraine was more common in the CEAD IS group (103 [30.8%] vs 525 [24.4%], P = .01), and the difference was mainly due to migraine without aura (80 [24.0%] vs 335 [15.6%], P < .001). Compared with migraine with aura, migraine without aura was independently associated with CEAD IS (OR, 1.74; 95% CI, 1.30-2.33). The strength of this association was higher in men (OR, 1.99; 95% CI, 1.31-3.04) and in patients 39.0 years or younger (OR, 1.82; 95% CI, 1.22-2.71). The risk factor profile was similar in migrainous and non-migrainous patients with CEAD IS (eg, hypertension, 20 [19.4%] vs 57 [24.7%], P = .29; diabetes, 1 [1.0%] vs 3 [1.3%], P > .99).

CONCLUSIONS:

In patients with ischaemic stroke  aged 18 to 45 years, migraine, especially migraine without aura, is consistently associated with cervical artery dissection. This finding suggests common features and warrants further analyses to elucidate the underlying biologic mechanisms.

This abstract is included in the neurochecklist:

Cervical artery dissection (CEAD): causes and risk factors

 Abstract link

Migraine. aka Tman on Flikr. https://www.flickr.com/photos/rundwolf/331545021

Does binge eating disorder contribute to IIH?

Impact of obesity and binge eating disorder on patients with idiopathic intracranial hypertension

Raggi A, Curone M, Bianchi Marzoli S, et al.

Cephalalgia 2017; 37:278-283.

Abstract

Background:

Idiopathic intracranial hypertension (IIH) is associated with obesity, and obesity is associated with binge eating disorder (BED). The aim of this paper is to address the presence and impact of BED in patients undergoing an IIH diagnostic protocol.

Methods:

This was a cross-sectional study. Consecutive patients suspected of IIH underwent neurological, neuro-ophthalmologic and psychological examinations, neuroimaging studies and intracranial pressure (ICP) measurements through lumbar puncture in the recumbent position. IIH diagnosis was based on International Classification of Headache Disorders, 2nd Edition criteria; BED diagnosis was based on Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria. The presence of oligoclonal bands (OCBs) in the cerebrospinal fluid was also assessed.

Results:

Forty-five patients were enrolled: 33 were diagnosed with IIH and five of them (15%) were obese with BED. Compared to non-obese patients, those who were obese, and particularly those who were obese with BED, were more likely to have an IIH diagnosis (χ2 = 14.3; p = 0.001), ICP > 200 mmH2O (χ2 = 12.7; p = 0.002) and history of abuse or neglect (χ2 = 11.2; p = 0.004). No association with OCBs was found.

Conclusions:

We reported for the first time the presence of binge eating disorder among patients with IIH and showed that BED is associated to IIH, ICP and history of abuse or neglect.

This reference is included in the neurochecklist:

Idiopathic intracranial hypertension (IIH): risk factors

Abstract link

By The U.S. Food and Drug Administration – https://www.flickr.com/photos/fdaphotos/18520422550/, Public Domain, Link

Do people with cluster headache have big skulls?

The cavernous sinus in cluster headache-a quantitative structural magnetic resonance imaging study

Arkink EB, Schoonman GG, van Vliet JA, et al.

Cephalalgia 2017; 37:208-213.

Abstract

Background:

It has been hypothesized that a constitutionally narrow cavernous sinus might predispose individuals to cluster headache. Cavernous sinus dimensions, however, have never been assessed.

Methods:

In this case-control study, we measured the dimensions of the cavernous sinus, skull base, internal carotid and pituitary gland with high-resolution T2-weighted magnetic resonance imaging in 25 episodic, 24 chronic and 13 probable cluster headache patients, 8 chronic paroxysmal hemicrania patients and 22 headache-free controls. Dimensions were compared between groups, correcting for age, sex and transcranial diameter. Results

Results:

On qualitative inspection, no relevant pathology or anatomic variants that were previously associated with cluster headache or chronic paroxysmal hemicranias were observed in the cavernous sinus or paracavernous structures. The left-to-right transcranial diameter at the temporal fossa level (mean ± SD) was larger in the headache groups (episodic cluster headache: 147.5 ± 7.3 mm, p = 0.044; chronic cluster headache: 150.2 ± 7.3 mm, p < 0.001; probable cluster headache: 146.0 ± 5.3 mm, p = 0.012; and chronic paroxysmal hemicrania: 145.2 ± 9.4 mm, p = 0.044) compared with controls (140.2 ± 8.0 mm). After adjusting for transcranial diameter and correcting for multiple comparisons, there were no differences in the dimensions of the cavernous sinus and surrounding structures between headache patients and controls.

Conclusion:

Patients with cluster headache or chronic paroxysmal hemicrania had wider skulls than headache-free controls, but the proportional dimensions of the cavernous sinus were similar.

This reference is now included in the neurochecklist:

Cluster headache (CH): clinical features

Abstract link

Cluster headache. Daniel Brown on Flikr. https://www.flickr.com/photos/danielbowen/4431146495

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