Peripheral Nerve Blocks and Trigger Point Injections in Headache Management: Trigeminal Neuralgia Does Not Respond to Occipital Nerve Block

Abstract

Ankle-Brachial Index in Migraineursh ead_1702 1215..1221To the editor:We read the article by Jurno et al 1 with great interest. Authors conducted a significant reduction of ankle-brachial index (ABI) in migraineurs. 1 As compared with our data of ABI in migraineurs on physical check-up, we would like to comment on conclusions of Jurno et al.Oscillometric ABI was measured in 123 migraineurs (22 with aura [MA] and 101 without aura [MO]) and 118 controls. Female ratio was 80% in both groups. Mean age (SD) was 42.1 (8.4) years in migraineurs and 42.7 (9.5) years in controls. Cardiovascular disease (CVD) risk profile of migraineurs suggested 6 subjects in hypertension, 3 in diabetes mellitus, 13 in dyslipidemia, 18 in current smoking, and 14 in obesity. Only 1 woman with MO had ABI values lower than 0.9. Her age was 29 years and no CVD risk factors existed. Mean ABI (SD) was 1.05 (0.06) in migraineurs and 1.06 (0.07) in controls. There were no significant differences of ABI values between among 4 groups of migraine, MA, MO sufferers and controls on multivariate logistic regression analysis adjusted by age, sex, and several CVD risk factors. Jurno et al 1 disclosed mean ABI (SD) of 0.94 (0.11) in 50 migraineurs and 0.99 (0.09) in 38 controls. ABI values <0.9 was found in 24 migraineurs (48%) and 7 controls (18%). Using logistical regression, odds ratio of ABI <0.9 was 3.9 in the migraine group. We would like to know the age and CVD risk profile in migraineurs and controls with decreased ABI. Arterial pressure was obtained with an ultrasonic Doppler device whereas we measured oscillometric ABI. As compared with oscillometric ABI, sensitivity and specificity of Doppler ABI (<0.9) were higher. 2 Mean age was 42.1 (8.4) years in our migraineurs and 36 (9.9) years of participants in the study of Jurno et al. 1 Methodological differences of ABI measurement and age of migraineurs may lead to diverse results between 2 studies. Authors provide the possibility that existence of migraine contributes to lower ABI. 1 Age distribution of migraineurs is suggested to peak from 20 to 50 years of age. Finally, long-term monitoring of ABI is needed whether atherosclerotic changes influence abnormal ABI in young or midlife migraineurs. We speculate that ABI abnormalities could play a crucial role in the dysregulation of vascular reactions in a part of migraineurs, rather than CVD risk or peripheral obstructive arterial disease.