Therapeutic Implications of Altered Energy Metabolism in Migraine: A State-of-the-Art Review

Hassan, Syed Adeel; Farooque, Umar; Choudhry, Ali Sanaullah; Pillai, Bharat; Sheikh, Fahad N

doi:10.7759/cureus.8571

Cited by 5 publications

(5 citation statements)

References 38 publications

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“…In light of these observations, B Guldiken et al [ 10 ] endorsed careful assessment for impaired glucose metabolism in patients with migraine. Various methods have emerged to correct insulin resistance or hyperinsulinism, such as insulin-sensitizing drugs, physical activity, and dietary interventions [ 21 , 22 ]. Ultimately, these therapeutic modalities are worthy of being evaluated from this perspective to assess their effects on migraine.…”

Section: Discussionmentioning

confidence: 99%

The potential impact of insulin resistance and metabolic syndrome on migraine headache characteristics

et al. 2022

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Background & objectives Studying comorbidities with migraine aids in a better understanding of its pathophysiology and potential therapeutic targets. This case-control study aimed to study the impact of insulin resistance and metabolic syndrome on the characteristics of migraine headache attacks. Methods A case-control study was conducted on 30 migraine patients and 30 healthy controls. The following data were assessed in migraine patients: type of migraine, duration of attacks, Migraine Severity Scale (MIGSEV), and Headache Impact Test-6 (HIT-6). Both groups were assessed for waist circumference and underwent the following tests: fasting blood glucose, fasting insulin, high-density lipoprotein cholesterol level, and triglycerides, and homeostasis model assessment–insulin resistance (HOMA-IR) was applied. Results This study included age and sex-matched patients and controls. Migraine patients had significantly higher waist circumference, higher mean values of serum insulin, HOMA-IR and higher frequency of insulin resistance and metabolic syndrome than the control group (P-value = 0.005, 0.049, 0.01, 0.012, 0.024, respectively). Migraine patients with insulin resistance had significantly higher intensity and tolerability scores, MIGSEV total score, and HIT-6 total score compared to those without (P-value = 0.005, 0.005, 0.002, 0.018, respectively). There was a significantly positive correlation between the MIGSEV and HIT-6 scores and fasting insulin levels, and HOMA-IR value (P-value = 0.006, ≤ 0.001, 0.017, ≤ 0.001, respectively). Conclusion Insulin resistance and metabolic syndrome are more common in migraine patients than in healthy controls. The severity and impact of migraine attacks are higher in patients with insulin resistance than in those without.

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Section: Discussionmentioning

confidence: 99%

The potential impact of insulin resistance and metabolic syndrome on migraine headache characteristics

et al. 2022

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“…Astrocytes support oxidative metabolism in neurons [ 36 ]. The astrocyte–neuron lactate shuttle enables the energetic coupling between the two [ 37 , 38 ]. Glucose crosses the endothelium from the arterial blood into the brain cells through isoforms of glucose transporters (GLTs) [ 38 , 39 ].…”

Section: The Role Of Astrocytes In Cortical Spreading Depressionmentioning

confidence: 99%

The Role of Astrocytes in Migraine with Cortical Spreading Depression: Protagonists or Bystanders? A Narrative Review

Yang,

Ren,

Pan

et al. 2024

Pain Ther

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Cortical spreading depression (CSD) is a slow wave of cortical depolarization closely associated with migraines with an aura. Previously, it was thought that CSD depolarization was mainly driven by neurons, with characteristic changes in neuronal swelling and increased extracellular potassium (K + ) and glutamate. However, the role of astrocytes, a member of the neurovascular unit, in migraine with CSD has recently received increasing attention. In the early stages of CSD, astrocytes provide neurons with energy support and clear K + and glutamate from synaptic gaps. However, in the late stages of CSD, astrocytes release large amounts of lactic acid to exacerbate hypoxia when the energy demand exceeds the astrocytes’ compensatory capacity. Astrocyte endfoot swelling is a characteristic of CSD, and neurons are not similarly altered. It is primarily due to K + influx and abnormally active calcium (Ca 2+ ) signaling. Aquaporin 4 (AQP-4) only mediates K + influx and has little role as an aquaporin. Astrocytes endfoot swelling causes perivascular space closure, slowing the glymphatic system flow and exacerbating neuroinflammation, leading to persistent CSD. Astrocytes are double-edged swords in migraine with CSD and may be potential targets for CSD interventions.

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“…[4] A pounding headache, or a sensation of fullness so over forehead, which appears during recurring episodes and is frequently unilateral, is the hallmark of migraine, a chronic neurological illness. [5] The signs of depression include melancholy, a lack of spirit, loss of pleasure, changes in eating and sleep patterns, and low energy that causes increasing lethargy that lasts for two weeks. The Global Health Organization (WHO) has identified clinically severe depression as the leading global cause of disability burden and suicide [6].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Depression in Migraine Patients: A Multicentre Cross-Sectional Study from Pakistan

Ullah¹,

Awan²,

Usman³

et al. 2022

PJMHS

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Objective: Aim of current study was to determine the frequency of depression in patients with migraine visiting to Neurology outpatient department. Study Design: Cross-sectional Place of study: Data was collected from different tertiary care hospitals of Pakistan, including Lady Reading Hospital, Peshawar, Ghulam Mahar medical college and United medical and Dental College, Karachi, during period from November, 2021 to April, 2022. Methods: Total 425 patients of both genders had age 18-70 years were included in this study. Included patients had migraine and visited outpatient department of Neurology. After obtaining informed written consent detailed demographics of enrolled cases included age, sex, education status and place of living were recorded. Frequency and severity of depression among all cases were assessed. SPSS 24.0 was used to analyze all data. Results: Among 425 patients, 265 (62.4%) were males and 160 (37.6%) patients were females.Mean age of the patients was 29.7±10.50 years with mean BMI 23.7±11.26 kg/m2. 230 (54.1%) were married and 195 (45.9%) were unmarried. There were 215(50.6%) patients educated and 210 (49.4%) cases were non-educated. 180 (42.4%) patients had migraine with aura and 245 (57.6%) patients were without aura. We found that 300 (70.6%) patients had depression among all cases. Among 300 cases of depression, frequency of mild was 75, moderate was 125 and severity of depression was found in 100 cases. Conclusion: We came to the conclusion that since migraine sufferers had a relatively high rate of depression, there may be a connection between migraine and depression. When assessing migraine patients for a favorable prognosis and appropriate illness care, depression shouldn't be disregarded. Keywords: Depression, Migraine, Aura

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Therapeutic Implications of Altered Energy Metabolism in Migraine: A State-of-the-Art Review

Cited by 5 publications

References 38 publications

The potential impact of insulin resistance and metabolic syndrome on migraine headache characteristics

The potential impact of insulin resistance and metabolic syndrome on migraine headache characteristics

The Role of Astrocytes in Migraine with Cortical Spreading Depression: Protagonists or Bystanders? A Narrative Review

Prevalence of Depression in Migraine Patients: A Multicentre Cross-Sectional Study from Pakistan

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