Insights into migraine attacks from neuroimaging

Messina, Roberta; Rocca, Maria A.; Goadsby, PJ; Filippi, Massimo

doi:10.1016/s1474-4422(23)00152-7

Cited by 9 publications

(7 citation statements)

References 93 publications

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“…Currently, we understand that hypothalamic dysfunction may be responsible for the initiation of migraine symptoms, particularly in the premonitory phase (81,82). However, the trigeminovascular system plays a pivotal role in migraine pain (83,84). The initiation of a migraine pain involves the activation of nociceptive inputs in sensory afferent nerves, specifically targeting the peripheral c-fibers and Aδ fibers of the trigeminal nerves located in the cerebral arteries and connecting the meninges with the pons and the trigeminal nucleus caudalis (85).…”

Section: Pathophysiology Of Migraine Progression As a Results Of Medi...mentioning

confidence: 99%

Medication “underuse” headache

Rattanawong,

Rapoport,

Srikiatkhachorn

2024

Cephalalgia

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Background Many risk factors have been associated with migraine progression, including insufficient and ineffective utilization of migraine medications; however, they have been inadequately explored. This has resulted in suboptimal usage of medications without effective altering of prescribing recommendations for patients, posing a risk for migraine chronification. Methods Our aim is to conduct a comprehensive review of the available evidence regarding the underuse of migraine medications, both acute and preventive. The term “underuse” includes, but is not limited to: ( 1 ) ineffective use of appropriate and inappropriate medication; ( 2 ) underutilization; ( 3 ) inappropriate timing of usage; and ( 4 ) patient dissatisfaction with medication. Results The underuse of both acute and preventive medications has been shown to contribute to the progression of migraine. In terms of acute medication, chronification occurs as a result of insufficient drug use, including failure of the prescriber to select the appropriate type based on pain intensity and disability, patients taking medication too late (more than 60 minutes after the onset or after central sensitization has occurred as evidenced by allodynia), and discontinuation because of lack of effect or intolerable side effects. The underlying cause of inadequate effectiveness of acute medication lies in its inability to halt the propagation of peripheral activation to central sensitization in a timely manner. For oral and injectable preventive migraine medications, insufficient efficacy and intolerable side effects have led to poor adherence and discontinuation with subsequent progression of migraine. The underlying pathophysiology here is rooted in the repetitive stimulation of afferent sensory pain fibers, followed by ascending brainstem pain pathways plus dysfunction of the endogenous descending brainstem pain inhibitory pathway. Although anti-calcitonin gene-related peptide (CGRP) medications partially address pain caused by the above factors, including decreased efficacy and tolerability from conventional therapy, some patients do not respond well to this treatment. Research suggests that initiating preventive anti-CGRP treatment at an early stage (during low frequency episodic migraine attacks) is more beneficial than commencing it during high frequency episodic attacks or when chronic migraine has begun. Conclusions The term “medication underuse” is underrecognized, but it holds significant importance. Optimal usage of acute care and preventive migraine medications could potentially prevent migraine chronification and improve the treatment of migraine attacks.

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Section: Pathophysiology Of Migraine Progression As a Results Of Medi...mentioning

confidence: 99%

Medication “underuse” headache

Rattanawong,

Rapoport,

Srikiatkhachorn

2024

Cephalalgia

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“…Furthermore, menstrual migraine and menstrual-related migraine are among the most common subtypes for female patients (20-25%) (Vetvik & MacGregor, 2021), with menstrual-related attacks being considered more debilitating (Pavlović et al, 2015). Over the past decades, magnetic resonance imaging (MRI) has provided insights beyond clinical assessment, revealing structural and functional brain alterations in migraine (Colombo et al, 2019;Messina et al, 2022Messina et al, , 2023.…”

Section: Introductionmentioning

confidence: 99%

Multilevel clinical fingerprinting: uncovering longitudinal changes in the functional connectome of the brain along the migraine cycle

Esteves,

Fouto,

Ruiz-Tagle

et al. 2024

Preprint

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Migraine is a common neurological disorder characterized by recurrent headache episodes alternating with symptom-free periods, which has been associated with alterations across large-scale functional brain networks albeit with variable findings. Critically, despite the cyclic nature of the disorder, longitudinal studies spanning the various phases of the migraine cycle are scarce. Here, we leverage the identifiability of individual functional connectomes (FC) to investigate changes along the migraine cycle. For this purpose, we employ a case-control longitudinal design to study a group of 10 patients with episodic menstrual or menstrual-related migraine without aura, in the 4 phases of their spontaneous migraine cycle (preictal, ictal, postictal, interictal), and a group of 14 healthy controls in corresponding phases of the menstrual cycle, using resting-state fMRI. We propose a novel multilevel clinical fingerprinting approach to analyse the differential FC identifiability within-subject, as well as within-session and within-group. The individual FC matrices are then reconstructed with 19 principal components maximizing identifiability at all levels, and analyzed with Network-Based Statistic to identify significant changes in FC strength. We observe decreased FC identifiability for patients in the preictal phase relative to controls, which increases with the progression of the attack and becomes comparable to controls in the interictal phase. Regarding the FC strength, is increased in the ictal and postictal phases relative to controls across several networks. Our novel multilevel clinical fingerprinting approach captures FC variations along the migraine cycle in a case-control longitudinal study, bringing new insights into the cyclic nature of the disorder.

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“…15 Neurotransmitters such as dopamine, orexin, vasopressin, and somastatin are released. 16 In 1899, Gowers described the premonitor phase as drowsiness. In 1980, it was joined by Blau as "complete migraine".…”

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confidence: 99%

“…Hypothalamic hyperactivation occurs during the premonitor phase . Neurotransmitters such as dopamine, orexin, vasopressin, and somastatin are released . In 1899, Gowers described the premonitor phase as drowsiness.…”

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confidence: 99%

Migraine and Its Treatment from the Medicinal Chemistry Perspective

Pehlivanlar,

Carradori,

Simsek

2024

ACS Pharmacol. Transl. Sci.

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Migraine is a disease of neurovascular origin that affects the quality of life of more than one billion people and ranks sixth among the most common diseases in the world. Migraine is characterized by a moderate or severe recurrent and throbbing headache, accompanied by nausea, vomiting, and photo-phonophobia. It usually starts in adolescence and is twice as common in women as in men. It is classified as with or without aura and has chronic or acute treatment types according to the frequency of occurrence. In acute treatment, analgesics that relieve pain in the fastest way are preferred, while there are different options in chronic treatment. While non-specific methods were used in the treatment of migraine until the 1950s, triptans, ditans, and CGRP-receptor-dependent therapies (monoclonal antibodies and gepants) started to be used in the clinic more recently. In this Review, we focus on the synthesis, side effects, and pharmacological and pharmacokinetic properties of FDA-approved drugs used in acute and preventive-specific treatment of migraine.

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Insights into migraine attacks from neuroimaging

Cited by 9 publications

References 93 publications

Medication “underuse” headache

Medication “underuse” headache

Multilevel clinical fingerprinting: uncovering longitudinal changes in the functional connectome of the brain along the migraine cycle

Migraine and Its Treatment from the Medicinal Chemistry Perspective

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