Dysautonomia in the pathogenesis of migraine

Gazerani, Parisa; Cairns, Brian E.

doi:10.1080/14737175.2018.1414601

Cited by 40 publications

(28 citation statements)

References 94 publications

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“…Many features of migraine, such as nausea, vomiting, and thirst, but also cranial autonomic symptoms such as lacrimation, nasal congestion, and rhinorrhea are indicative of altered autonomic function in the central nervous system (CNS) . As such, it has been shown that alterations in sympathetic and parasympathetic tone can be found from the premonitory phase through to postdrome . One proposal is that migraine triggers, such as stress, awakening, or other changes in physiological or emotional homeostasis, activate nociceptive pathways through increased parasympathetic tone .…”

Section: Phase 1: Premonitorymentioning

confidence: 99%

A Phase‐by‐Phase Review of Migraine Pathophysiology

2018

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Migraine is a common, disabling neurological disorder characterized by multiple phases: premonitory, aura, headache, postdrome, and interictal. Our understanding of the pathophysiology of each phase of migraine has evolved over recent years. The premonitory phase begins as early as 3 days before the headache phase, and involves a complex interplay between various cortical and subcortical brain regions, including the hypothalamus and brainstem nuclei that modulate nociceptive signaling. The headache phase involves activation of the trigeminovascular system, a pathway that is well characterized. In one‐third of patients, an aura phase may occur during some attacks and likely correlates with a cortical spreading depression‐like event; a slowly propagating wave of neuronal and glial cell depolarization and hyperpolarization. Improved characterization of the pathophysiological processes involved at each stage of the migraine attack will aid the identification of new therapeutic targets for migraine prevention. This review provides an update on prevailing concepts of migraine pathophysiology.

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Section: Phase 1: Premonitorymentioning

confidence: 99%

A Phase‐by‐Phase Review of Migraine Pathophysiology

2018

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“…Therefore, if this important meal is skipped, the neurological system will be deprived of some essential macronutrients and micronutrients (33). As reported in previous studies, hunger has a key role in the incidence of primary headaches (39). In addition, breakfast preparation is an active behavior that involves individuals in social activity (40); through which it might further help in preventing primary headaches.…”

Section: Discussionmentioning

confidence: 96%

Breakfast consumption is inversely associated with primary headaches in university students: The MEPHASOUS study

Mansouri

Sharifi

Shokri

et al. 2019

Preprint

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Background The prevalence of primary headaches has been increasing at an alarming rate, particularly in university students. Previous studies have shown that diet-related behaviors can affect neurological disorders. Therefore, this study was conducted to examine the association between breakfast consumption patterns and primary headaches in a large population of university students.Methods In total, 83,677 university students, aged ≥18 years, from 28 provinces of Iran were included in the current cross-sectional study. Dietary intakes and breakfast consumption patterns were assessed using a validated self-administered dietary habits questionnaire. Primary headaches were determined according to the International Classification of Headache Disorders-3 (ICHD-3) criteria.Results The mean age of participants was 21.50 ± 4.01. Primary headaches were prevalent among 9% of university students. A significant inverse association was seen between breakfast consumption and odds of primary headaches (OR: 0.57, 95% CI: 0.51-0.62). This association remained significant even after taking potential confounders into account; such that students who consumed breakfast frequently had 26% lower odds of primary headaches compared with those who consumed it rarely (OR: 0.74, 95% CI: 0.65-0.85). Moreover, such a significant inverse association was observed in female students (OR: 0.54, 95% CI: 0.49-0.61) as well as those with normal weight (OR: 0.68, 95% CI: 0.58-0.79). However, it became non-significant in male students and those with overweight or obesity.Conclusions We found that frequent breakfast consumption was inversely associated with the odds of primary headaches. Further prospective studies are needed to confirm our findings.

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“…Similar to CH, dysautonomias also accompany migraine attacks [106]; however, it is too early to comment on any potential effects of DBS on dysautonomias in migraine. (1) DBS of the posterior hypothalamus over time decreases hypothalamic output, decreasing trigeminal sensory neuron excitability.…”

Section: Figurementioning

confidence: 99%

Medical Hypothesis: Deep Brain Stimulation for Intractable Migraine

Gazerani¹,

Cairns

2021

OBM Neurobiology

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Deep Brain Stimulation (DBS) has been introduced as an innovative treatment for several neurological disorders, including Parkinson’s disease, essential tremor, and dystonia and it has been proven effective in helping individuals affected by these disorders; hence, enhancing their quality of life. DBS has also been investigated for the treatment of cluster and other primary headaches. Electrodes are surgically implanted into brain structures, for example the posterior hypothalamus in case of cluster headache. Hypothalamic DBS has been successfully used to treat patients with cluster headache and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). In these headache conditions, DBS may reduce headache frequency by half, however, some side effects have also been reported that are mainly related to infection where the electrodes are placed, syncope, and diplopia. Hypothalamic DBS is proposed to modulate neuronal structures that are directly or indirectly involved in detection or transmission of painful stimuli or in the processing of this information. Reports of the use of DBS for chronic migraine are not found in the literature. This commentary explores the medical hypothesis that DBS could be considered as a therapeutic option for intractable chronic migraine. This hypothesis is based on the commonalities between cluster headache and migraine in terms of some shared symptoms, and potential overlap of underlying mechanisms. However, due to the absence of clinical evidence supporting the use of DBS in CM, the fact that disease-specific optimization of DBS parameters must be considered carefully, and considering the optimal CNS structures to target are currently unknown, it is concluded that this interventional and invasive technique should be avoided for CM for the present time.

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Dysautonomia in the pathogenesis of migraine

Cited by 40 publications

References 94 publications

A Phase‐by‐Phase Review of Migraine Pathophysiology

A Phase‐by‐Phase Review of Migraine Pathophysiology

Breakfast consumption is inversely associated with primary headaches in university students: The MEPHASOUS study

Medical Hypothesis: Deep Brain Stimulation for Intractable Migraine

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