Search

Перспективным в изучении биомаркеров мигрени может быть многолокусный анализ, в частности, анализ частот сочетанных генотипов. Цель исследования - поиск составных генетических биомаркеров индивидуальной предрасположенности к мигрени, полученных на основе полиморфизмов генов, уже показавших статистическую значимость при однолокусном ассоциативном анализе. Методика. Обследовано 155 пациентов с мигренью (104 пациента с эпизодической мигренью, 51 - с хронической мигренью), наблюдавшихся в Университетской клинике головной боли (Москва). Все пациенты - представители белой расы, жители Московского региона. Возраст пациентов - 30-50 лет. Контроль составили 365 необследованных лиц (популяционный контроль). Выявление исследуемых 22 генов (всего 31 SNP) осуществляли методом ПЦР, ПЦР-ПДРФ, аллель-специфичной ПЦР и ПЦР в реальном времени. Выявление ассоциированных с мигренью сочетанных генотипов проводили с использованием программы анализа полигенных данных APSampler v3.6. Результаты. Выявлено 8 сочетанных генотипов с высокой статистически значимой ассоциацией с мигренью (ОШ>20,0). В состав сочетанных генотипов вошли гены: CCKAR, CCKBR, COMT, MTHFR, MTR, MTRR. Так же выявлено 4 защитных сочетанных генотипа (ОШMultilocus analysis, specifically, analysis of combined genotype frequencies may be promising in studying migraine biomarkers. The aim of the study was to search for composite genetic biomarkers, which would predict individual predisposition to migraine, obtained on the basis of gene polymorphisms that have already shown a statistical significance in a single-locus associative analysis. Methods. 155 patients with migraine aging 41.7 ± 12.5 who had been followed up at the University Clinic of Headache, Moscow, were evaluated (104 patients with episodic migraine and 51 with chronic migraine). All patients were white and residents of the Moscow region. The control group included 365 unexamined individuals (population control). Identification of The 22 genes under study (total, 31 SNPs) were identified by PCR, PCR-RFLP, allele-specific PCR, and real-time PCR. Combined genotypes associated with migraine were identified using the APSampler v3.6 software for polygenic data analysis. Results. Eight combined genotypes were identified with a highly significant association with migraine (OR> 20.0). The combined genotypes included the CCKAR, CCKBR, COMT, MTHFR, MTR, and MTRR genes. Four protective combined genotypes were also identified (OS

We review the role of dopamine in the mechanisms of development of primary headaches, including migraine. Some data are given about the involvement of various types of dopamine receptors in the regulation of cranial blood flow and control of nociceptive transmission in the trigeminal nerve system. We discuss the role of the basal ganglia in the neurobiology of cephalgias. One part of the review is focused on dopaminergic drugs that may be used in the therapy of migraine.

Recommendations for the diagnosis and treatment of migraine based on the principles of evidence-based medicine are presented. The latest edition of the International Classification of Migraine is provided. Diagnostic methods and criteria are oriented to discriminating different types of migraine. Recommendations are given on the basis of data on the epidemiology and pathophysiological mechanisms of migraine. The most effective medication-based and non-medication-based approaches to the management of migraine patients are discussed.

According to rough estimates, at least one third of the population in developed countries suffers, to varying degrees, from certain forms of primary headache, the modern pharmacotherapy of which is not always effective and has a number of limitations. The non-pharmacological treatment of headache can be an alternative to the prescription of pharmacological agents and the only possible assistance option for patients developing drug-resistant cephalalgias. This review describes various methods of electrical neuromodulation that are used for the management of primary headaches. The authors provide information on current stages in implementation of implantable and non-invasive equipment into clinical practice, which makes possible electrical stimulations of peripheral nerves and of the sphenopalatine ganglion, as well as allows transcranial magnetic stimulation. Also the appearance and usage of portable electrical devices available on the world market are described, and mechanisms that can underlie anticephalgic action of neuromodulation therapy are discussed. Special attention is paid to the methods that are applied for electrostimulation of the vagus nerve and occipital nerves.По приблизительным оценкам не менее трети населения развитых стран в разной степени страдает от тех или иных форм первичных головных болей (ГБ), фармакотерапия которых не всегда эффективна и имеет ряд ограничений. Немедикаментозное лечение ГБ может быть альтернативой назначению фармакологических средств и единственно возможным вариантом оказания помощи пациенту при развитии у него лекарственно-резистентной цефалгии. В обзоре рассмотрены различные методы электрической нейромодуляции, использующиеся в терапии первичных ГБ. Приведена информация об этапах внедрения в клиническую практику имплантируемых и неинвазивных устройств, позволяющих осуществлять электростимуляцию периферических нервов и крылонебного узла, а также выполнять транскраниальное магнитное воздействие. Описаны способы применения доступных на мировом рынке портативных электротехнических устройств и обсуждены механизмы антицефалгического действия нейромодулирующей терапии. Особое внимание уделено методам электростимуляции блуждающего и затылочных нервов.

Background The non-invasive biomarkers of migraine can help to develop the personalized medication of this disorder. In testing of the antimigraine drugs the capsaicin-induced skin redness with activated TRPV1 receptors in sensory neurons associated with the release of the migraine mediator CGRP has already been widely used. Methods Fourteen migraine patients (mean age 34.6 ± 10.2 years) and 14 healthy volunteers (mean age 29.9 ± 9.7 years) participated in the experiment. A new arrangement of imaging photoplethysmography recently developed by us was used here to discover novel sensitive parameters of dermal blood flow during capsaicin applications in migraine patients. Results Blood pulsation amplitude (BPA) observed as optical-intensity waveform varying synchronously with heartbeat was used for detailed exploration of microcirculatory perfusion induced by capsicum patch application. The BPA signals, once having appeared after certain latent period, were progressively rising until being saturated. Capsaicin-induced high BPA areas were distributed unevenly under the patch, forming “hot spots.” Interestingly the hot spots were much more variable in migraine patients than in the control group. In contrast to BPA, a slow component of waveforms related to the skin redness changed significantly less than BPA highlighting the latter parameter as the potential sensitive biomarker of capsaicin-induced activation of the blood flow. Thus, in migraine patients, there is a non-uniform (both in space and in time) reaction to capsaicin, resulting in highly variable openings of skin capillaries. Conclusion BPA dynamics measured by imaging photoplethysmography could serve as a novel sensitive non-invasive biomarker of migraine-associated changes in microcirculation.

These recommendations on the diagnosis and treatment of migraine were elaborated by Russian headache experts in accordance with the evidence-based practice. Together with the latest classification, diagnostic principles and criteria of different clinical sub-forms the consensus contains basic data on migraine epidemiology, pathophysiological mechanisms, differential diagnosis and most effective and evidence based approaches to pharmacological and non-pharmacological management of migraine patients.Представленные рекомендации по диагностике и лечению мигрени составлены на основании принципов доказательной медицины. Приведена Международная классификация мигрени последнего пересмотра. Методы диагностики и диагностические критерии ориентированы на различные формы мигрени. Рекомендации даны на основе сведений об эпидемиологии и патофизиологических механизмах мигрени. Охарактеризованы наиболее эффективные лекарственные и немедикаментозные подходы к ведению пациентов с мигренью.

Migraine is one of the most common forms of primary headaches; it affects nearly 10% of the population in developed countries. All major CNS neurotransmitter systems are implicated in migraine pathogenesis, indicating the polyneurochemical nature of the nosology. This review is focused on the role of gamma-aminobutyric acid (GABA) and its receptors in the neurobiology of migraine. The report describes evidence for the existence of a cause-effect relationship between impaired GABA metabolism and development of the disease. It summarizes data on the distribution of GABA-A and GABA-B receptors in the trigeminovascular system and on the contribution of GABA to the modulation of nociceptive neurotransmission in the trigemino-thalamo-cortical pathway. As well, it provides detailed information on the mechanisms that underlie GABA-ergic inhibition at the peripheral, spinal, and suprasegmental levels. In the end, we discuss the pharmacodynamics of some GABA-positive drugs that are used for prophylactic and acute treatments of migraine, as well as other primary headaches.

This review is focused on the role of noradrenalin and its receptors in the pathogenesis of primary headaches, in particular, migraine headaches. The data are summarized on the involvement of different adrenoreceptors in the regulation of tone of cerebral vessels and modulation of transmission of nociceptive information in the trigeminovascular system and at the supraspinal level of the CNS. We discuss the pharmacodynamics of several adrenergic drugs that are used for prophylactic treatment of migraine headaches.

Recent studies indicate that migraine is associated with increased risk of cardiovascular diseases. However, links between autonomic cardiovascular regulation, arterial hypertension (AH) and migraine are still little explored. In this study, we evaluated autonomic regulation in migraine patients with and without hypertension. We studied 104 patients with migraine, aged 34±10 y, including 28 with and 76 without hypertension (M+AH and M-AH groups, respectively). The control group consisted of 88 healthy volunteers matched by age and sex. The autonomic regulation of circulation was examined with the tilt-table test, deep-breathing and Valsalva Maneuver, handgrip test, cold-stress induced vasoconstriction, arterial baroreflex, and blood pressure variability measurements. We found that migraine patients with concomitant hypertension demonstrated reduced arterial baroreflex, whereas other parameters of cardiac autonomic regulation were unchanged. In contrast, most indicators of vasomotor reactivity (blood pressure response to the hand-grip, Valsalva maneuver and cold vasoconstriction) were enhanced in migraine patients with no significant differences between migraine patients with and without hypertension. Patients from both M+AH and M-AH groups more commonly had a family history of cardiovascular disorders. Our data revealed increased vasomotor reactivity in migraine patients, with or without concomitant hypertension. This was associated with the family history of cardiovascular diseases.

Article, Background The autonomous cardiovascular control can contribute to progression of migraine. However, current data on cardiovascular reactivity in migraine, especially severe forms, are essentially contradictory. The main aim of this study was to compare the autonomous regulation of circulation in patients with episodic and chronic migraine and healthy subjects. Methods Seventy three migraine patients (mean age 35 ± 10) including episodic migraine (51 patients, 4–14 headache days/months) and chronic migraine (22 patients, ≥15 headache days/month) along with age-match control (71 healthy voluntaries) were examined. The autonomic regulation of circulation was examined with the tilt-table test, a deep breathing and Valsalva Maneuver, handgrip test, cold-stress vasoconstriction, arterial baroreflex and blood pressure variability. Results The changes in heart rate induced by deep breathing, Valsalva Maneuver, and blood pressure in tilt-table test in patients with migraine did not differ from the control group. In contrast, the values of cold-stress-vasoconstriction forearm blood-flow reactivity (p, published version, peerReviewed

Migraine is the third most common disease in the world. The overall prevalence of migraine in the Russian Federation is estimated at 20% with an estimated global prevalence of 14.7%. Migraine affects mostly people of working age and has a significant negative impact on the quality of life, the level of adaptation, ability to work, social functioning. Migraine represents a significant social and economic burden for patients and society as a whole. A team of national experts on migraine offers a program to prioritize quality of management of patients with headache.Мигрень является третьим по распространенности заболеванием в мире. Общая распространенность мигрени в Российской Федерации составляет 20%, а глобальная распространенность - 14,7%. Заболевание поражает в основном лиц трудоспособного возраста, оказывает существенное негативное влияние на качество жизни, уровень адаптации, трудоспособность, социальное функционирование больных и является значительным социальным и экономическим бременем для пациентов и общества в целом. В статье представлена программа российских экспертов по вопросам мигрени по приоритизации качества ведения пациентов с головной болью.

Migraine attacks are caused by a CNS dysfunction, that activates trigemino-vascular system and is subsequently followed by neurogenic inflammation, dilatation of the cerebral blood vessels, and headache In patients with migraine with aura it has been demonstrated that vascular dilatation at the height of a migraine attack is accompanied by cerebral hyperperfusion According to the majority of studies, cerebral hemodynamic changes are homolateral to the unilateral headache side, and may be confined either to the frontal “ temporal“ parietal region.