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Background.—Modification of migraine-associated cerebrovascular reactivity may provide insight into the mechanism of action of a given therapeutic intervention. Methods.—With transcranial Doppler and a breath-holding index, cerebrovascular reactivity to hypercapnia was evaluated in 20 patients with migraine without aura interictally and in 11 healthy controls. Patients were started on prophylactic treatment with flunarizine 10 mg per day, and measurements were repeated at the end of every month for 3 months. Headache status was evaluated clinically via a headache index. Headache index; breath-holding index; systolic, diastolic, and mean blood flow velocities; and pulsatility index measurements were recorded at every session. Results.—The baseline breath-holding index was significantly higher in the migraine group compared to the control group (P = .002). No difference in other parameters was found between the groups. The change in the headache index was significant (P <.001), indicating a beneficial effect from flunarizine. The breath-holding index improved significantly after treatment (P <.001), and the baseline difference in the breath-holding index between the pretreatment migraine group and the control group was no longer evident at 3 months. There was no significant change with treatment in the other transcranial Doppler parameters. Conclusion.—Our finding of unchanged blood flow velocities but normalized cerebrovascular reactivity after treatment suggests that the mechanism of action of flunarizine in migraine does not involve a vasodilatory effect on cerebral vessels. It may be instead that flunarizine modifies cerebrovascular reactivity through its action on centrally located structures that subserve autonomic vascular control. [ABSTRACT FROM AUTHOR]

Objective: The endo-opioid and endo-cannabinoid systems are important in regulating pain and have been implicated in migraine pathophysiology. Patients with frequent attacks, such as patients with chronic migraine (CM), frequently develop medication overuse headache (MOH). Not all patients with chronic headache develop M0H, the reason for which is not exactly known. We aimed to assess the involvement of these neurotransmitter systems in episodic and CM and in M0H. Materials and Methods: Patients with (episodic migraine; n = 29), (CM; n=15), MOH (n=16) and 31 healthy controls were recruited and blood levels of nociceptin and anandamide (AEA) were compared between groups, as well as their levels with headache parameters. Results: AEA levels were significantly lower in the combined migraine groups compared to controls (p = 0.009), but head to head comparison of the groups revealed no significant difference (p = 0.062). Median nociceptin levels were found to be very high in CM (235.76 ng/l) group and very low in MOH (30.08 ng/l) group, but the difference was not statistically significant. Conclusion: Our finding of low AEA levels in migraine supports the hypothesis of a dysfunctional endocannabinoid system in migraine. Although our results failed to reveal any differences between episodic and CM, an interpretation of findings reported in the literature suggested that this low endocannabinoid inhitory tone might contribute to nociceptive facilitation resulting in maintained central sensitization and therefore sustained pain in CM. Although not significant, nociceptin levels were much higher in CM group and the lowest levels were found in MOH group. It is possible that in CM, the opioid system tries to counterbalance the endocannabinoid dysfunction and if the opioid levels fail to rise, the patient is driven to an excessive use of analgesics and MOH develops. Although we were unable to prove this hypothesis we think it would be worthwhile studying this hypothesis in a larger group of patients. [ABSTRACT FROM AUTHOR]

We designed this multicenter study to evaluate the abnormalities related to the mast cell activation during attacks in a large group of migraineurs and to compare the findings both with episodic tension type headache (ETTH) and matched healthy control subjects. After the evaluation of diagnostic criteria, 213 subjects were included in this study after giving consent. Of all 146 subjects (67.8%) were migraineurs, 38 (19.4%) were ETTH patients and 29 others were healthy controls matched according to age and sex. Immunological screening showed significantly high ratios of IL-1β, IL-2, IL-6 and TNF-α in the migraine group compared to ETTH (16.6% vs 10.5%, 20.0% vs 5.3%, 13.8% vs 2.6% and 15.9% vs 5.3%, respectively) and to the healthy controls. Logistic regression analysis showed that only duration of headache has an important effect on having IL-2 abnormality (Exp-B: 0.322, 95% CI: 0.151-0.688, p=0.003) in patients with migraine. There was no important effect of clinical variables on serological abnormalitites or each other. In conclusion, our multicenter clinical and laboratory based study suggests that primary headache disorders (migraine and ETTH) are associated with atopic changes and they might share the inflammatory mechanism (proinflammatory as well as anti-inflammatory cytokine abnormalities) during headache attacks. [ABSTRACT FROM AUTHOR]

Objective. To study the efficacy and tolerability of 1 g of intravenous magnesium sulfate as acute treatment of moderate or severe migraine attacks. Background. Migraine is a common disorder in which not only the pain but also the accompanying symptoms such as nausea and vomiting reduce activity and productivity of sufferers. Many drugs used for the treatment of acute migraine attacks have many side effects, are not well tolerated, are ineffective in some patients, or cannot be used during pregnancy or in patients with ischemic heart disease. Magnesium deficiency has been proposed to play a role in the pathophysiology of migraine, and recently treatment of migraine with magnesium has gained considerable interest. Methods. This was a randomized, single-blind, placebo-controlled trial including 30 patients with moderate or severe migraine attacks. Fifteen patients received 1 g intravenous magnesium sulfate given over 15 minutes. The next 15 patients received 10 mL of 0.9% saline intravenously. Those in the placebo group with persisting complaints of pain or nausea and vomiting after 30 minutes also received 1 g magnesium sulfate intravenously over 15 minutes. The patients were assessed immediately after treatment, and then 30 minutes and 2 hours later. Intensity of pain, accompanying symptoms, and side effects were noted. Results. All patients in the treatment group responded to treatment with magnesium sulfate. The pain disappeared in 13 patients (86.6%); it was diminished in 2 patients (13.4%); and in all 15 patients (100%), accompanying symptoms disappeared. In the placebo group, a decrease in pain severity but persisting nausea, irritability, and photophobia were noted in 1 patient (6.6%). Accompanying symptoms disappeared in 3 patients (20%) 30 minutes after placebo administration. All patients initially receiving placebo were subsequently given magnesium sulfate. All of these patients responded to magnesium sulfate. In 14 patients (93.3%), the attack ended;... [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to demonstrate whether blood Orexin A levels (OX-AL), which are a marker of hypothalamic activity, are altered in patients with migraine and whether they differ ictally and interictally and with the chronification of migraine. Materials and Methods: A total of 113 patients participated in this study. Orexin A blood samples were taken during a headache-free interval. In 17 patients with episodic migraine a second blood sample for Orexin A was taken during an attack of migraine. Results: OX-AL were lower in episodic migrane compared to controls but did not differ during an attack and the interictal period. Conclusion: Our findings of low OX-AL in episodic migrane both ictally and interictally, similar levels of OX-AL in chronic migraine and tension-type headache compared to controls may suggest that OX-AL is probably not released in response to acute pain but its basal levels may modulate the susceptibility to pain. Basal OX-AL are low in patients with episodic migrane which could reflect a suppression of the orexinergic system due to hypothalamic dysfunction but increase with chronification possibly in response to lower Orexin-A receptor density secondary to neurodegeneration. Further larger studies may shed more light on the role of the orexinergic system and the hypothalamus in migraine and the chronification of it. [ABSTRACT FROM AUTHOR]

Objectives.—The aim of this study is to assess the comprehensibility, internal consistency, patient-physician reliability, test-retest reliability, and validity of Turkish version of Migraine Disability Assessment (MIDAS) questionnaire in patients with headache. Background.—MIDAS questionnaire has been developed by Stewart et al and shown to be reliable and valid to determine the degree of disability caused by migraine. Design and Methods.—This study was designed as a national multicenter study to demonstrate the reliability and validity of Turkish version of MIDAS questionnaire. Patients applying to 17 Neurology Clinics in Turkey were evaluated at the baseline (visit 1), week 4 (visit 2), and week 12 (visit 3) visits in terms of disease severity and comprehensibility, internal consistency, test-retest reliability, and validity of MIDAS. Since the severity of the disease has been found to change significantly at visit 2 compared to visit 1, test-retest reliability was assessed using the MIDAS scores of a subgroup of patients whose disease severity remained unchanged (up to ±3 days difference in the number of days with headache between visits 1 and 2). Results.—A total of 306 patients (86.2% female, mean age: 35.0 ± 9.8 years) were enrolled into the study. A total of 65.7%, 77.5%, 82.0% of patients reported that “they had fully understood the MIDAS questionnaire” in visits 1, 2, and 3, respectively. A highly positive correlation was found between physician and patient and the applied total MIDAS scores in all three visits (Spearman correlation coefficients were R= 0.87, 0.83, and 0.90, respectively, P < .001). Internal consistency of MIDAS was assessed using Cronbach's α and was found at acceptable (>0.7) or excellent (>0.8) levels in both patient and physician applied MIDAS scores, respectively. Total MIDAS score showed good test-retest reliability ( R= 0.68). Both the number of days with headache and the total MIDAS scores were positively correlated at all visits with correlation coefficients between 0.47 and 0.63. There was also a moderate degree of correlation ( R= 0.54) between the total MIDAS score at week 12 and the number of days with headache at visit 2 + visit 3, which quantify headache-related disability over a 3-month period similar to MIDAS questionnaire. Conclusion.—These findings demonstrated that the Turkish translation is equivalent to the English version of MIDAS in terms of internal consistency, test-retest reliability, and validity. Physicians can reliably use the Turkish translation of the MIDAS questionnaire in defining the severity of illness and its treatment strategy when applied as a self-administered report by migraine patients themselves. [ABSTRACT FROM AUTHOR]