Headache
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Glutamate (Glu) and glutamine (Gln) are strongly compartmentalized (in neurons for Glu and in astrocytes for Gln). The visual cortex is the brain region with a higher neuron/astrocyte ratio (the highest neuronal density and the relatively lowest density of astrocytes). Elevations in extracellular Glu or potassium above certain thresholds are likely candidates to be the final common steps in the multiple distinct processes that can lead to cortical spreading depression. Astrocytes play a key role in this phenomenon, by acting as a sink for extracellular Glu and potassium, as well as generally acting as a buffer for the ionic and neurochemical changes that initiate and propagate cortical spreading depression. ⋯ These findings are consistent with glutamatergic differences in migraine patients during the interictal period compared with healthy controls. We hypothesize that an increased Glu/Gln ratio could arise from neuronal-glial coupling of glutamatergic metabolism differences or an increased neuron/astrocyte ratio in the OC.
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To assess the prevalence of headache in clinic and support group patients with celiac disease and inflammatory bowel disease (IBD) compared with a sample of healthy controls. ⋯ Migraine was more prevalent in celiac disease and IBD subjects than in controls. Future studies should include screening migraine patients for celiac disease and assessing the effects of gluten-free diet on migraines in celiac disease.
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The aim of this study was to investigate the utility of pain descriptors (pain quality, pain intensity) assessed in a questionnaire to discriminate tension-type headache (TTH) from TTH plus migraine in a sample of adolescents. ⋯ Pain intensity and quality assessed by questionnaires are not suitable to discriminate TTH from TTH plus migraine. This may lead to inaccurate prevalence estimates in epidemiological studies and may mislead practitioners in forming diagnostic hypotheses. The exclusion of these pain descriptors in questionnaires should be considered. More research systematically assessing the diagnostic utility of verbal pain descriptors in primary care and epidemiological samples is needed.
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While nausea is a defining feature of migraine, the association of nausea with other headache features and its influence on the burden of migraine have not been quantified. Population-based data were used to elucidate the relative frequency and burden of migraine-associated nausea in persons with migraine. ⋯ High-frequency migraine-associated nausea is common and is a marker for severe, debilitating migraine. Nausea makes an independent contribution to migraine-associated disability and impact. Management strategies that take nausea into account could reduce the burden of migraine. Nausea is an important target for monitoring and treatment.
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Allodynia is considered a phenomenon of central sensitization that may lead to migraine transformation, lowering the attack threshold. Migraine triggers are factors that may induce headache attacks in susceptible individuals. We hypothesize that because allodynia decreases the migraine-attack threshold, allodynic migraineurs are more susceptible to triggers than the non-allodynic ones. ⋯ Migraineurs with moderate/severe allodynia had more triggers than those with no/mild allodynia. It is unknown if those with moderate/severe allodynia are more susceptible to triggers, or repetitive stimulation of the trigeminal system by triggers resulted in moderate/severe allodynia.