Perceptions of Modulatory Factors in Migraine and Epilepsy: A Multicenter Study

Abstract

Background: Migraine and epilepsy are both common episodic disorders, typically precipitated or inhibited by some modulatory factors (MFs).Objective: To assess the self-perception of MFs in patients with migraine (PWM) compared to patients with epilepsy (PWE) with a standardized protocol in different countries.Methods: Transcultural multicenter comparative cross-sectional study. All consecutive patients who fulfilled the ICHD-3 criteria for migraine and ILAE's criteria for epilepsy, with at least 1 year of follow-up were interviewed with a semi-structured questionnaire on clinical and epidemiological data and were asked to identify all experienced MFs from a provided list.Results: A total of 608 individuals were surveyed at five university referral centers in Brazil, Guatemala, Lithuania and Turkey. Two hundred and nineteen (91.6%) PWM and 305 (82.7%) PWE identified attack precipitating factors (PFs; p < 0.001). The most frequent three PFs reported by epilepsy patients were: “lack of sleep” (56.6%), “emotional stress” (55.3%), “negative feelings” (53.9%), while among migraine patients “emotional stress” (81.6%), “lack of sleep” (77.8%), “negative feelings” (75.7%) were cited. Inhibitory factors (IFs) for the episodes were reported by 68 (28.5%) PWM and 116 (31.4%) PWE. “Darkness” was the most common one, described by 35.6% of PWM whereas “positive feelings” reported by 10.6% of PWE. Most MFs are concordant across the countries but some transcultural differences were noted.Conclusion: The MFs of migraine and epilepsy attacks and their varying frequencies according to different countries were investigated with the same standardized questionnaire, for the first time. MFs were recognized very often in both migraine and epilepsy cohorts, but in distinct disease-specific prevalence, being more frequent in migraine. Recognition of self-perceived MFs may be helpful for the management of both illnesses.

Migraine triggers in Asian countries: a narrative review

“…Eight out of 10 papers investigating Travel are from Southern Asia (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). In Western Asia, Food/eating habits were the common triggering factors compared to other areas in Asia (37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54).…”

“…In Western Asia, where the majority of the population is Muslim, Food/eating habits , especially hunger, were highly reported as migraine triggers compared with other countries in Asia. Some papers investigate about specific food/beverage as migraine triggers such as coffee, cheese, chocolate ( 39 , 45 , 47 , 48 ), which are well-known migraine triggers, but mostly nothing particular for food/beverage in the region. Rather, most of papers from Western Asia focused on food as a whole and/or hunger.…”

“…One way to reduce such bias and clarify the geographical or racial characteristics in migraine triggers may be to conduct a multicenter study or a survey targeting population groups. Ur Özçelik et al ( 45 ) conducted a multicenter study in Turkey, Brazil, Guatemala, and Lithuania and reported notable differences in migraine triggers among the countries (i.e., chewing in Lithuania, physical stress in Brazil, and pleasant tastes in Turkey showed a higher migraine-provoking rate than in other countries). Carod-Atral et al conducted a cross-cultural study in Spain and Brazil and reported that Brazilians, compared to Spanish, were more likely to consider a condition as a trigger in nearly all categories, such as stress and sleep disturbances.…”

“…Rather, most of papers from Western Asia focused on food as a whole and/or hunger. This is thought to be associated with Ramadan, the month of fasting, one of the five fundamental practices in Islam (37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54). A recent study reported a significant increase in migraine frequency during the month of Ramadan compared with the previous month (57).…”

Clinical and Instrumental Follow-Up of Childhood Absence Epilepsy (CAE): Exploration of Prognostic Factors

“…About 50% of epileptic patients complain of post-critical headache, and at times headache can be the only symptom of an epileptic seizure (ictal epileptic headache) [ 32 ]. Both disorders display similar precipitating factors such as lack of sleep, emotional stress, negative feelings [ 33 ]. They share several clinical features and have intertwined genetic and molecular underpinnings [ 34 ].…”