Brain stem and cerebellar hyperintense lesions in migraine. (57/210)

BACKGROUND AND PURPOSE: Migraineurs are at increased risk of cerebellar infarcts and supratentorial white matter lesions. The prevalence, frequency, and distribution of infratentorial hyperintense lesions in migraine are unknown. METHODS: Migraineurs with aura (n=161), without aura (n=134), and controls (n=140) from a population-based sample of adults (30 to 60 years of age) were evaluated with MRI. RESULTS: Infratentorial hyperintensities were identified in 13 of 295 (4.4%) migraineurs and in 1 of 140 (0.7%) controls (P=0.04). Twelve cases had hyperintensities, mostly bilaterally, in the dorsal basis pontis. Those with infratentorial hyperintensities also had supratentorial white matter lesions more often. CONCLUSIONS: We found an increased prevalence of infratentorial (mostly pontine) hyperintensities in migraineurs from the general population. This extends the knowledge about vulnerable brain regions and type of lesions in migraine brains. A hemodynamic ischemic pathogenesis is likely, but further research is needed.  (+info)

Interaction of somatoform and vestibular disorders. (58/210)

BACKGROUND: The high coincidence of organic vestibular and somatoform vertigo syndromes has appeared to support pathogenic models showing a strong linkage between them. It was hypothesised that a persisting vestibular dysfunction causes the development of anxiety disorders. OBJECTIVE: To determine the relation between vestibular deficits and somatoform vertigo disorders in an interdisciplinary prospective study. METHODS: Participants were divided into eight diagnostic groups: healthy volunteers (n=26) and patients with benign paroxysmal positioning vertigo (BPPV, n=11), vestibular neuritis (n=11), Meniere's disease (n=7), vestibular migraine (n=15), anxiety (n=23), depression (n=12), or somatoform disorders (n=22). Neuro-otological diagnostic procedures included electro-oculography with rotatory and caloric testing, orthoptic examination with measurements of subjective visual vertical (SVV) and ocular torsion, and a neurological examination. Psychosomatic diagnostic procedures comprised interviews and psychometric instruments. RESULTS: Patients with BPPV (35.3%) and with vestibular neuritis (52.2%) had pathological test values on caloric irrigation (p<0.001). Otolith dysfunction with pathological tilts of SVV and ocular torsion was found only in patients with vestibular neuritis (p<0.001). Patients with Meniere's disease, vestibular migraine, and psychiatric disorders showed normal parameters for vestibular testing but pathological values for psychometric measures. There was no correlation between pathological neurological and pathological psychometric parameters. CONCLUSIONS: High anxiety scores are not a result of vestibular deficits or dysfunction. Patients with Meniere's disease and vestibular migraine but not vestibular deficits showed the highest psychiatric comorbidity. Thus the course of vertigo syndromes and the possibility of a pre-existing psychopathological personality should be considered pathogenic factors in any linkage between organic and psychometric vertigo syndromes.  (+info)

Diffusion tensor magnetic resonance imaging at 3.0 tesla shows subtle cerebral grey matter abnormalities in patients with migraine. (59/210)

BACKGROUND AND OBJECTIVE: Diffusion tensor (DT) magnetic resonance imaging (MRI) has the potential to disclose subtle abnormalities in the brain of migraine patients. This ability may be increased by the use of high field magnets. A DT MRI on a 3.0 tesla scanner was used to measure the extent of tissue damage of the brain normal appearing white (NAWM) and grey matter in migraine patients with T2 visible abnormalities. METHODS: Dual echo, T1 weighted and DT MRI with diffusion gradients applied in 32 non-collinear directions were acquired from 16 patients with migraine and 15 sex and age matched controls. Lesion load on T2 weighted images was measured using a local thresholding segmentation technique, and brain atrophy assessed on T1 weighted images using SIENAx. Mean diffusivity and fractional anisotropy histograms of the NAWM and mean diffusivity histograms of the grey matter were also derived. RESULTS: Brain atrophy did not differ between controls and patients. Compared with healthy subjects, migraine patients had significantly reduced mean diffusivity histogram peak height of the grey matter (p=0.04). No diffusion changes were detected in patients' NAWM. In migraine patients, no correlation was found between T2 weighted lesion load and brain DT histogram derived metrics, whereas age was significantly correlated with grey matter mean diffusivity histogram peak height (p=0.05, r=-0.52). CONCLUSIONS: DT MRI at high field strength discloses subtle grey matter damage in migraine patients, which might be associated with cognitive changes in these patients.  (+info)

Migraine with aura: visual disturbances and interrelationship with the pain phase. Vaga study of headache epidemiology. (60/210)

In the Vaga study of headache epidemiology, 1838 or 88.6% of the available 18-65-year-old inhabitants of the commune were included. Everyone was questioned and examined personally by the principal investigator (OS). There were 178 cases of various types of visual disturbances during the migraine attack, which corresponds to 9.7% of the study group. The prevalence among females was 11.9% and among males 7.4%; female/male ratio was 1.70, as against 1.05 in the total Vaga study population. By far the most frequently occurring visual disturbance pattern was (A) 1. Visual disturbances --> 2. pain-free interlude --> 3. pain phase (in 78% of the cases). Other frequent patterns were: (B). Visual disturbances, but no pain phase (24%); and: (C) 1. Pain phase --> 2. visual disturbances (23%). Evidently, in the solitary case, there might be more than one visual disturbance pattern. The most frequently occurring solitary visual disturbances were: scintillating scotoma (62%) and obscuration (33%); but also more rare ones were identified, like anopsia, autokinesis (movement of stationary objects), tunnel vision and micropsia. Among the non-visual aura disturbances, paraesthesias and speech disturbances were the most frequent ones. The prevalence of migraine with aura seemed to be considerably higher than in similar studies. This also includes studies that have been carried out with a face-to-face interview technique.  (+info)

Hypomania as an aura in migraine. (61/210)

We report a 19-year-old man presenting to the department of Psychiatry for the evaluation of prominent behavioral symptoms associated with episodic headaches, with normal inter-episodic periods. A diagnosis of classic migraine with hypomanic aura was made. Other possible co-morbid or causative illnesses were excluded and preventive therapy with valproate was started due to the prominent affective symptoms as a part of the migranous aura. With this the frequency of headaches gradually decreased over the next four months. He was followed up for 2 years when he was found to be symptom-free. Recent research into the mechanisms of migraine has identified that the cortical hyperexcitability and an imbalance between neuronal inhibition and excitement mediated by gamma-aminobutyric acid and excitatory amino acids respectively may be the underlying mechanism. The high rate of affective disorders in patients with migraine, association of migraine with an aura comprising of mood symptoms and good response to treatment with mood-stabilisers might give newer insights into the pathophysiology of mood disorder as well.  (+info)

Diagnostic challenge--is this really a stroke? (62/210)

BACKGROUND: Although acute stroke most commonly presents with hemiparesis, facial weakness and dysphasia, these symptoms can sometimes be the atypical presentations of other conditions which may be difficult to diagnose. OBJECTIVE: This article presents three cases of stroke mimics and discusses how to improve accuracy in diagnosing stroke in the primary care setting. DISCUSSION: Stroke is a medical emergency and urgent hospital transfer is vital. Hypoglycaemia, hyperglycaemia, epilepsy, multiple sclerosis, hemiplegic migraine, intracranial tumours or infection (meningitis/encephalitis/abscess) can all mimic stroke. The Los Angeles Prehospital Stroke Screen (LAPSS) consists of four history items, a blood glucose measure, and three examination items designed to detect unilateral motor weakness. It can be utilised to improve the accuracy in diagnosing stroke and stroke mimics in general practice.  (+info)

Anatomical alterations of the visual motion processing network in migraine with and without aura. (63/210)

BACKGROUND: Patients suffering from migraine with aura (MWA) and migraine without aura (MWoA) show abnormalities in visual motion perception during and between attacks. Whether this represents the consequences of structural changes in motion-processing networks in migraineurs is unknown. Moreover, the diagnosis of migraine relies on patient's history, and finding differences in the brain of migraineurs might help to contribute to basic research aimed at better understanding the pathophysiology of migraine. METHODS AND FINDINGS: To investigate a common potential anatomical basis for these disturbances, we used high-resolution cortical thickness measurement and diffusion tensor imaging (DTI) to examine the motion-processing network in 24 migraine patients (12 with MWA and 12 MWoA) and 15 age-matched healthy controls (HCs). We found increased cortical thickness of motion-processing visual areas MT+ and V3A in migraineurs compared to HCs. Cortical thickness increases were accompanied by abnormalities of the subjacent white matter. In addition, DTI revealed that migraineurs have alterations in superior colliculus and the lateral geniculate nucleus, which are also involved in visual processing. CONCLUSIONS: A structural abnormality in the network of motion-processing areas could account for, or be the result of, the cortical hyperexcitability observed in migraineurs. The finding in patients with both MWA and MWoA of thickness abnormalities in area V3A, previously described as a source in spreading changes involved in visual aura, raises the question as to whether a "silent" cortical spreading depression develops as well in MWoA. In addition, these experimental data may provide clinicians and researchers with a noninvasively acquirable migraine biomarker.  (+info)

Comorbidity in Finnish migraine families. (64/210)

The objective of the study was to investigate comorbidity of migraine in Finnish migraine families. One thousand consecutive participants in the Finnish Migraine Gene Project reported their medical illnesses in addition to migraine and headache. Migraine patients (n=678) reported significantly more hypotension (OR 1.43, CI 95% 1.02-2.01), allergy (OR 1.83, CI 95% 1.34-2.51) and psychiatric disorders (OR 4.09, CI 95% 2.11-7.92) compared to their family members without migraine (n=322). Subgroup analyses demonstrated that especially women and the group fulfilling the criteria for both migraine with and without aura were likely to have additional disorders besides their migraine. Interestingly, male migraineurs with aura reported a significant association with stroke and epilepsy. Familial migraine is comorbid with hypotension, allergy and psychiatric disorders. The association between migraine with aura and stroke and epilepsy among men of the studied families warrants further study. Clinical, pathophysiological and genetic implications of these results are discussed.  (+info)