RESUMO
INTRODUCTION: There is controversy as to whether migraine affects the behavior of ischemic penumbra during the acute phase of an ischemic stroke, thereby accelerating the formation of cerebral infarction. OBJECTIVES: To assess whether migraine modifies the existence and volume of the divergence between the areas of diffusion and perfusion in the stroke (the penumbra) and whether migraine implies a poorer prognosis after the stroke. METHODS: This was a prospective cohort study. We included hospitalized patients with ischemic stroke within 72 h of symptom onset (convenience sampling). A semi-structured questionnaire, the National Institute of Health Stroke Scale, and the modified Rankin Scale (mRS) were used. Patients underwent magnetic resonance imaging (MRI) of the brain with diffusion and with perfusion. Patients were assessed by telephone 3 months after the stroke to determine the prognosis. Scores of > 2 on the mRS were considered to have a poor prognosis. RESULTS: A total of 221 patients were included, 131/221 (59%) of whom were male, and with a mean (SD) age of 68.2 (13.8) years. Ischemic penumbra analysis was performed in 118 patients. There was no association between migraine and the absence of ischemic penumbra (16/63 [25%] vs. 12/55 [22%]; odds ratio 1.22, 95% confidence interval 0.52-2.87; p = 0.64). There was no difference in stroke volume between those with and without migraine (median [interquartile range] 1.0 [0.4-7.9] vs. 1.8 [0.3-9.4] cm3 ; p = 0.99). Migraine was not associated with the stroke prognosis after multivariable analysis. CONCLUSION: Migraine is not associated with the absence of ischemic penumbra, the volume of the ischemic penumbra, or the stroke prognosis.
Assuntos
AVC Isquêmico , Transtornos de Enxaqueca , Acidente Vascular Cerebral , Humanos , Masculino , Idoso , Feminino , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Encéfalo/patologia , Prognóstico , Transtornos de Enxaqueca/patologia , Imagem de Difusão por Ressonância Magnética/métodosRESUMO
Objective The main goal of this study was to correlate migraine improvement, after prophylactic therapy, with cortical thickness changes. Methods Cortical thickness maps were obtained with magnetic resonance imaging (MRI) from 19 patients with migraine before (first scan) and after (second scan) prophylactic treatment, and these were compared with controls using the FreeSurfer MRI tool. Cortical changes were correlated with the headache index (HI). Results Anincrease incortical thickness was found in the right cuneus and precuneus, somatosensory and superior parietal cortices in both patient scans, compared with the controls. No changes were observed in the left hemisphere. Following correction for multiple comparisons, no areas changed from the first to the second scan. Regression analysis showed a significant negative correlation between the HI improvement and cortical thickness changes in the left posterior cingulate, a region involved with nociception and, possibly, the development of chronic pain. Conclusion There were changes in cortical thickness in patients with migraine relative to controls in areas involved with vision and pain processing. Left posterior cingulate cortical changes correlated with headache frequency and intensity.
Assuntos
Giro do Cíngulo/patologia , Transtornos de Enxaqueca/patologia , Transtornos de Enxaqueca/prevenção & controle , Adulto , Estudos de Casos e Controles , Feminino , Giro do Cíngulo/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Transtornos de Enxaqueca/diagnóstico por imagem , Método de Monte Carlo , Tamanho do Órgão , Profilaxia Pós-Exposição/métodos , Valores de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Resultado do Tratamento , Adulto JovemRESUMO
ABSTRACT Objective The main goal of this study was to correlate migraine improvement, after prophylactic therapy, with cortical thickness changes. Methods Cortical thickness maps were obtained with magnetic resonance imaging (MRI) from 19 patients with migraine before (first scan) and after (second scan) prophylactic treatment, and these were compared with controls using the FreeSurfer MRI tool. Cortical changes were correlated with the headache index (HI). Results Anincrease incortical thickness was found in the right cuneus and precuneus, somatosensory and superior parietal cortices in both patient scans, compared with the controls. No changes were observed in the left hemisphere. Following correction for multiple comparisons, no areas changed from the first to the second scan. Regression analysis showed a significant negative correlation between the HI improvement and cortical thickness changes in the left posterior cingulate, a region involved with nociception and, possibly, the development of chronic pain. Conclusion There were changes in cortical thickness in patients with migraine relative to controls in areas involved with vision and pain processing. Left posterior cingulate cortical changes correlated with headache frequency and intensity.
RESUMO Objetivos Correlacionar a melhora de pacientes enxaquecosos após tratamento preventivo com alterações na espessura do córtex cerebral. Métodos Espessura cortical foi determinada a partir de imagens de ressonância magnética (RM)em 19 pacientes com enxaqueca, antes (1ᵃ RM) e após (2ᵃ RM) o tratamento profilático, e comparada com controles, usando o programa FreeSurfer. Mudanças corticais foram correlacionadas com o índice de cefaleia (HI). Resultados O hemisfério direito apresentou aumento da espessura no córtex do cúneus e pré-cúneus, parietal superior e somatossensitivo na primeira RM e na segunda RM, em comparação aos controles. Após correção para comparações múltiplas, nenhuma região cortical se mostrou estatisticamente diferente entre a primeira e a segunda RM. A regressão mostrou correlação (negativa) significativa entre melhora do HI e mudanças na espessura cortical do cíngulo posterior esquerdo. Conclusão Existem alterações de espessura cortical em pacientes com enxaqueca em relação a controles em áreas envolvidas com processamento visual e com a dor. As alterações corticais no cíngulo posterior esquerdo variaram de acordo com a frequência e intensidade das crises.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Giro do Cíngulo/patologia , Transtornos de Enxaqueca/patologia , Transtornos de Enxaqueca/prevenção & controle , Tamanho do Órgão , Valores de Referência , Índice de Gravidade de Doença , Imageamento por Ressonância Magnética/métodos , Estudos de Casos e Controles , Método de Monte Carlo , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento , Estatísticas não Paramétricas , Profilaxia Pós-Exposição/métodos , Giro do Cíngulo/diagnóstico por imagem , Transtornos de Enxaqueca/diagnóstico por imagemRESUMO
Headache can be attributed to cranial or cervical vascular disorders including ischemic stroke or transient ischemic attack, non-traumatic intracranial hemorrhage, unruptured vascular malformation, arteritis, carotid-vertebral artery pain, and cerebral venous thrombosis. Here, we present a case report of unruptured saccular aneurysm with migraine. The patient was a previously healthy 32-year-old man with repeated episodes of headache for 6 years. Findings for computed tomography and magnetic resonance imaging of the head were normal. Head magnetic resonance angiography revealed a small, nodule-like protuberance seen in the anterior communicating artery. Based on his clinical features and ancillary examinations, the patient was diagnosed with migraine without aura. The patient subsequently underwent digital subtraction angiography (DSA), which revealed a 2-mm cystic protuberance in the superoposterior anterior communicating artery. The patient underwent stent-assisted coil embolization of the aneurysm. Subsequent DSA results indicated no recurrence of aneurysm and no recurrence of headache was reported after surgical treatment.
Assuntos
Aneurisma/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Transtornos de Enxaqueca/diagnóstico por imagem , Stents , Adulto , Aneurisma/patologia , Aneurisma/terapia , Angiografia Digital , Humanos , Aneurisma Intracraniano/patologia , Imageamento por Ressonância Magnética , Masculino , Transtornos de Enxaqueca/patologia , Transtornos de Enxaqueca/terapia , Tomografia Computadorizada por Raios XRESUMO
Migraine is the most frequent type of headache in children. In the 1980s, scientists first hypothesized a connection between migraine and mitochondrial (mt) disorders. More recent studies have suggested that at least some subtypes of migraine may be related to a mt defect. Different types of evidence support a relationship between mitochondria (mt) and migraine: (1) Biochemical evidence: Abnormal mt function translates into high intracellular penetration of Ca(2+), excessive production of free radicals, and deficient oxidative phosphorylation, which ultimately causes energy failure in neurons and astrocytes, thus triggering migraine mechanisms, including spreading depression. The mt markers of these events are low activity of superoxide dismutase, activation of cytochrome-c oxidase and nitric oxide, high levels of lactate and pyruvate, and low ratios of phosphocreatine-inorganic phosphate and N-acetylaspartate-choline. (2) Morphologic evidence: mt abnormalities have been shown in migraine sufferers, the most characteristic ones being direct observation in muscle biopsy of ragged red and cytochrome-c oxidase-negative fibers, accumulation of subsarcolemmal mt, and demonstration of giant mt with paracrystalline inclusions. (3) Genetic evidence: Recent studies have identified specific mutations responsible for migraine susceptibility. However, the investigation of the mtDNA mutations found in classic mt disorders (mt encephalomyopathy with lactic acidosis and stroke-like episodes, myoclonus epilepsy with ragged red fibers, Kearns-Sayre syndrome, and Leber hereditary optic neuropathy) has not demonstrated any association. Recently, 2 common mtDNA polymorphisms (16519CâT and 3010GâA) have been associated with pediatric cyclic vomiting syndrome and migraine. Also, POLG mutations (eg, p.T851 A, p.N468D, p.Y831C, p.G517V, and p.P163S) can cause disease through impaired replication of mtDNA, including migraine. Further studies to investigate the relationship between mtDNA and migraine will require very large sample sizes to obtain statistically significant results. (4) Therapeutic evidence: Several agents that have a positive effect on mt metabolism have shown to be effective in the treatment of migraines. The agents include riboflavin (B2), coenzyme Q10, magnesium, niacin, carnitine, topiramate, and lipoic acid. Further study is warranted to learn how mt interact with other factors to cause migraines. This will facilitate the development of new and more specific treatments that will reduce the frequency or severity or both of this disease.
Assuntos
Transtornos de Enxaqueca/genética , Transtornos de Enxaqueca/metabolismo , Transtornos de Enxaqueca/patologia , Doenças Mitocondriais/genética , Doenças Mitocondriais/metabolismo , Doenças Mitocondriais/patologia , DNA Mitocondrial/genética , Humanos , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/tratamento farmacológico , Doenças Mitocondriais/complicações , Doenças Mitocondriais/tratamento farmacológico , Mutação , Vitaminas/uso terapêuticoRESUMO
Familial hemiplegic migraine type 1 (FMH-1) is a rare form of migraine with aura, which is characterized by transient hemiparesis, sensory loss and visual disturbances. This monogenic disease shares many common features with classic migraine, suggesting a similar molecular pathophysiology. Migraine is triggered by activation and sensitization of the trigeminovascular system, specifically the trigeminal nociceptive afferents innervating the meninges. Aura migraine is associated with cortical spreading depression (CSD), which is a short-lasting intense wave of neuronal and glial cell depolarization that slowly progresses over the cortex and is followed by long-lasting neuronal activity depression.
Assuntos
Canais de Cálcio/metabolismo , Ataxia Cerebelar/metabolismo , Cefaleia/metabolismo , Transtornos de Enxaqueca/metabolismo , Animais , Canais de Cálcio/genética , Ataxia Cerebelar/genética , Ataxia Cerebelar/patologia , Humanos , Camundongos , Transtornos de Enxaqueca/genética , Transtornos de Enxaqueca/patologia , Neurônios/metabolismo , Neurônios/patologiaRESUMO
Las cefaleas constituyen una causa frecuente de consulta en Pediatría, siendo la migraña el tipo más frecuente de las cefaleas primarias en la infancia. La asociación entre cefalea y hemiplejía aguda en la infancia pudiera corresponder a múltiples etiologías debiéndose considerar las de carácter hereditario. La migraña hemipléjica familiar se caracteriza por la presencia de crisis migrañosas con trastornos motores deficitarios transitorios, afasia o alteraciones sensitivas o sensoriales. Se describe el caso de una adolescente femenina de 12 años de edad, con antecedentes familiares de migraña, historia de cefalea migrañosa de un año de evolución, que cumple con los criterios establecidos por la Sociedad Internacional de Cefaleas de migraña hemipléjica familiar. El examen neurológico y los paraclínicos complementarios fueron normales. Se realizó tratamiento con flunarizina e ibuprofeno con evolución satisfactoria
Headaches are a frequent cause of consultation in Pediatrics, migraine being the most common type of primary headaches in children. The association between headache and acute hemiplegia in childhood may correspond to multiple etiologies, including those considered as inherited. Familial hemiplegic migraine is characterized by the presence of migraine crisis with transient motor deficit disorders, aphasia and sensitive or sensory disturbances. We describe the case of a 12 year-old girl with a family history of migraine, and migraine headache of a year of evolution, which meets the criteria established by the International Headache Society of Familial Hemiplegic Migraine. Neurological examination and the paraclinical studies were normal. She was treated with flunarizine and ibuprofen with satisfactory outcome
Assuntos
Humanos , Feminino , Adolescente , Flunarizina/uso terapêutico , Enxaqueca com Aura/diagnóstico , Enxaqueca com Aura/terapia , Transtornos de Enxaqueca/patologia , Transtornos de Enxaqueca/terapia , PediatriaRESUMO
Alrededor del 5% de la población padece de cefaleas durante más de 15 días por mes. Esta situación implica un elevado costo personal y social. Las cefaleas crónicas en su mayoría son migrañas crónicas y es importante que los facultativos tengan la información necesaria para su diagnóstico y tratamiento, de esta forma se evitarán gastos innecesarios en métodos de estudio inadecuados y se podrá aliviar a los pacientes con las estrategias actuales al alcance, ya sean abordajes no farmacológicos o utilizando drogas de reconocida acción, aprobadas para este fin y con pleno conocimiento de sus efectos. En caso de que lo anterior no resulte eficaz, se podrá analizar la posible implementación de tratamientos invasivos, como los implantes de estimuladores u otras técnicas quirúrgicas. En este artículo se efectúa una puesta al día de los conceptos actuales.
Assuntos
Terapias Complementares/instrumentação , Terapias Complementares/métodos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/patologia , Transtornos de Enxaqueca/terapiaRESUMO
Alrededor del 5% de la población padece de cefaleas durante más de 15 días por mes. Esta situación implica un elevado costo personal y social. Las cefaleas crónicas en su mayoría son migrañas crónicas y es importante que los facultativos tengan la información necesaria para su diagnóstico y tratamiento, de esta forma se evitarán gastos innecesarios en métodos de estudio inadecuados y se podrá aliviar a los pacientes con las estrategias actuales al alcance, ya sean abordajes no farmacológicos o utilizando drogas de reconocida acción, aprobadas para este fin y con pleno conocimiento de sus efectos. En caso de que lo anterior no resulte eficaz, se podrá analizar la posible implementación de tratamientos invasivos, como los implantes de estimuladores u otras técnicas quirúrgicas. En este artículo se efectúa una puesta al día de los conceptos actuales.(AU)
Assuntos
Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/patologia , Transtornos de Enxaqueca/terapia , Terapias Complementares/instrumentação , Terapias Complementares/métodosRESUMO
OBJECTIVE: To evaluate the number of immune cells in the peripheral blood of medication-overuse headache (MOH), chronic migraine (CM), and migraine without aura (MWA) patients, as well as from controls. BACKGROUND: Migraine has been linked to immunologic disturbances, but the role of the immune system in chronic forms of headache that evolve from migraine has not been studied. Psychiatric co-morbidity has been related to both headache chronification and immunologic alterations. METHODS: This cross-sectional study comprised 68 subjects divided in 4 groups: MOH, CM, MWA, control. Subjects were gender-matched, had no physical co-morbidity, and were taking only acetaminophen. Clinical and psychological data were recorded in a standardized protocol. Samples of peripheral blood for hematological analysis were obtained in the morning during the ictal (MOH, CM, and MWA groups) and interictal periods (MWA group), as well from control group. RESULTS: A higher lymphocyte count was measured in MOH patients relative to the MWA patients (mean ± standard deviation: 2448.7/mm3 ± 775.8 vs. 1859.7/mm3 ± 564.7; P = .027). The numbers of blood lymphocytes for CM and control subjects were 2086.1/mm3 ± 540.5 and 1961.7/mm3 ± 385.6, respectively. Multiple linear regression analysis demonstrated that only MOH and MWA groups remained associated with lymphocyte count (B = 540.7; CI 95%: 55.2-1026.1; P = .03; R2 = 19.2%). Analysis for linearity of variables in the spectrum control/MWA/CM/MOH resulted positive for body mass index (from 23.5 ± 3.25 in controls to 26.5 ± 4.49 in MOH patients; P = .034), scores on Beck Depression Inventory (from 3.29 ± 3.05 to 14.65 ± 11.21; P < 0.001) and Hamilton Anxiety Scale (from 4.29 ± 3.93 to 23.24 ± 11.01; P < 0.001), hemoglobin (from 13.7 ± 0.79 to 14.6 ± 1.31; P = .022), and lymphocyte count (from 1961.7 ± 385.6 to 2448.7 ± 775.8; P = .01), but negative for CD8+ T lymphocytes (from 34.0 ± 8.82 to 30.0 ± 6.64; P = .046). CONCLUSIONS: A higher lymphocyte count in the MOH group relative to the MWA group may indicate a chronic inflammatory state. Several clinical and laboratorial characteristics have a range along a spectrum extending from healthy subjects to patients suffering from chronic forms of migraine.