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Fulltext Poor tolerance of motor cortex rTMS in chronic migraine

Teo WP, Kannan A, Loh PK, Chew E, Sharma VK, Chan YC

J Clin Diagn Res, 2014 Sep;8(9):MM01-2.
PMID: 25386478 DOI: 10.7860/JCDR/2014/9377.4886

BACKGROUND: Two small studies had evaluated the efficacy of rTMS in migraine. One tested high frequency rTMS over the dorsolateral prefrontal cortex while the other evaluated 1 Hz rTMS over the vertex.
AIM: To test the feasibility of 10 Hz rTMS of motor cortex as an adjunctive therapy in patients with chronic migraine
Materials and Methods: We randomized (2:1 ratio) chronic migraine patients on medical preventive treatment to receive either rTMS or sham therapy for 10 sessions. rTMS (80% resting motor threshold, 10Hz, 20 trains, 5 secs/train, inter-train interval 1 min, total 1000 stimuli/session) was applied over the right motor cortex.
RESULT: Nine patients were randomized. Six received rTMS and three had sham therapy. Three patients in the rTMS arm withdrew from the study due to increased headache frequency and discomfort from the treatment. The remaining six cases (3 rTMS, 3 sham) completed the study. The study was prematurely stopped due to the significant worsening of headache from rTMS. No significant differences in outcome measures were found between real and sham rTMS.
CONCLUSION: Although the study was terminated prematurely, the high dropout rate (50%) due to worsening headaches suggested that rTMS over the motor cortex is poorly tolerated in chronic migraine.
KEYWORDS: Adverse effect; Central sensitization; Chronic migraine; Cortical excitability; Headache; rTMS
Study site: Neuroscience clinic of National University Hospital, Singapore

Matched MeSH terms: Migraine Disorders*
Fulltext The electroencephalogram changes in migraineurs

Tan HJ, Suganthi C, Dhachayani S, Rizal AM, Raymond AA

Med J Malaysia, 2007 Mar;62(1):56-8.
PMID: 17682573 MyJurnal

Migraine is associated with a variety of electroencephalographic (EEG) changes. Previous studies using analogue EEG and old diagnostic criteria may under or over report the prevalence of EEG changes in migraine. The objective of this study was to reevaluate the EEG changes in migraine patients diagnosed by applying the new International Classification of Headache Disorder -2 criteria. This was a case control study involving 70 migraine patients and 70 age and gender matched control who were subjected to scalp EEG. The EEG changes during hyperventilation (HV), which were significantly more common in the migraine group were theta activity (34 vs 22, p = 0.038) and frontal intermittent rhythmic delta activity (FIRDA) (10 vs 3, p = 0.042). Applying the new ICHD -2 diagnostic criteria and digital EEG, this study yielded previously unrecognized features including FIRDA during HV on EEG.

Matched MeSH terms: Migraine Disorders/classification; Migraine Disorders/diagnosis*
Fulltext Coexistence of CACNA1A, ATP1A2, and KCNN3 gene mutation in migraine patients with human platelet polymorphism

Bhaskar S, Abdullah JM, Ghazali MM

Neurosciences (Riyadh), 2008 Oct;13(4):356-8.
PMID: 21063360

OBJECTIVE: To look for any possible coexistence of CACNA1A, ATP1A2, and KCNN3 gene mutations in migraine patients who had human platelet HPA-1a/1b polymorphism, which is also known as PlA1/A2 polymorphism.
METHODS: The study was carried out at the Neurology Clinic, Hospital University Sains Malaysia, Kelantan, Malaysia between April 2004 and March 2005. The DNA from 4 patients who had migraine with the HPA1a/1b polymorphism were analyzed by polymerase chain reaction using the allele specific oligonucleotide technique to detect the presence of CACNA1A, ATP1A2, and KCNN3 genotypes.
RESULTS: We found that the CACNA1A gene mutation alone was present in only one patient who presented with classical migraine with aura. The gene mutations on ATP1A2 and KCNN3 were seen in none of our 4 cases with migraine.
CONCLUSION: There is no coexistence between the platelet HPA-1a/1b polymorphism and the ATP1A2 and KCNN3 gene mutations, though one classical migraine patient with HPA-1a/1b polymorphism had the CACNA1A gene mutation. Larger studies are warranted to confirm these findings.
Study site: Neurology Clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia

Matched MeSH terms: Migraine Disorders*
Geographical Differences in Trigger Factors of Tension-Type Headaches and Migraines

Tai MS, Yet SXE, Lim TC, Pow ZY, Goh CB

Curr Pain Headache Rep, 2019 Feb 21;23(2):12.
PMID: 30790108 DOI: 10.1007/s11916-019-0760-6

In this review, we discussed the types and frequencies of trigger factors of primary headache [migraine and tension-type headache (TTH)] among adult patients. We assessed the influence of geographical location, ethnicity and gender on the various trigger factors of a migraine and a TTH. We also evaluated the trigger factors among the multi-ethnic Southeast Asian adult patients. In a recent study, odor triggered more migrainous headaches compared to the other primary headaches. Odor was observed to be specific of migraines. Moreover, stress is one of the most common trigger factors for patients with migraines and TTHs worldwide. Migrainous patients have an increased sensitivity in comparison to non-migrainous patients. Furthermore, these patients have much difficulty in adapting to the high level of sensitivity, and the sensitized brain is therefore more vulnerable to trigger factors. In addition, the presence of one trigger factor may increase the exposure of other trigger factors. This phenomenon is more marked in the patients with migraines who have stress and menstruation as triggers, predisposing them to be more sensitive to other triggers. In conclusion, the geographical location factor has an influence on the trigger factors of headaches. Ethnicity may have an effect due to the cultural differences. Change in weather and sunlight are important commonly identified trigger factors for headaches. Moreover, gender differences in some trigger factors are present among the patients with headaches, especially sunlight and sleep deprivation. More research studies can be conducted to have a better understanding on trigger factors in the future. This will enable proper identification of trigger factors, leading to a decrease in the number of headache episodes and an improvement in quality of life for patients.

Matched MeSH terms: Migraine Disorders/etiology; Migraine Disorders/epidemiology*
Fulltext Clinical features of migraine in Malaysians

Kam CS

Med J Malaysia, 1982 Mar;37(1):14-7.
PMID: 7121341

This is a report of clinical features of migraine in Malaysians. Seventeen migraineurs were studied with respect to age, sex, length of disease, headache, aura, nausea, frequency, remission, precipitating factors, relieving factors, family history, coexisting symptoms, coexisting disease, and type of migraine. Similarities and differences between Malaysian and Caucasian migraineurs are discussed.

Matched MeSH terms: Migraine Disorders*
Do folate, vitamins B₆ and B₁₂ play a role in the pathogenesis of migraine? The role of pharmacoepigenomics

Shaik MM, Tan HL, Kamal MA, Gan SH

CNS Neurol Disord Drug Targets, 2014;13(5):828-35.
PMID: 24040787

Migraine is a neurovascular disease that has classically been attributed to multifactorial aetiologies, with genetic components and environmental interactions considered the main influence. Genes such as flavoenzyme 5, 10- methylenetetrahydrofolate reductase (MTHFR), especially the C677T variant, have been associated with elevated plasma homocysteine levels. This elevation in homocysteine results in an array of metabolic disorders and increased risk of complex diseases, including migraine. Catalysation of homocysteine requires the presence of vitamins B6, B12 and folate. Deficiencies in these cofactor vitamins result in hypomethylation, which triggers migraine. Because migraine predominantly affects females, it is hypothesised that fluctuating oestrogen levels, which are governed by oestrogen receptor 1 polymorphisms, are important. Another important factor is homocysteine, the production of which is dependent upon MTHFR and B vitamins. Gene expression is modulated through epigenetic mechanisms, which involve methionine. Additionally, folate plays a major role in DNA synthesis. We propose that vitamin B intake, coupled with MTHFR and oestrogen receptor 1 polymorphisms, causes differential DNA methylation and gene expression that may contribute to the occurrence of migraine.

Matched MeSH terms: Migraine Disorders/etiology; Migraine Disorders/genetics*; Migraine Disorders/metabolism
Fulltext Plasma calcitonin gene-related peptide: A potential biomarker for diagnosis and therapeutic responses in pediatric migraine

Fan PC, Kuo PH, Lee MT, Chang SH, Chiou LC

Front Neurol, 2019;10:10.
PMID: 30733702 DOI: 10.3389/fneur.2019.00010

Background: Plasma calcitonin gene-related peptide (CGRP) plays a key role in the migraine pathophysiology. This study aimed to investigate its role in predicting diagnosis and outcome of pharmacotherapy in pediatric migraine. Methods: We prospectively recruited 120 subjects, who never took migraine-preventive agents in a pediatric clinic, including 68 patients with migraine, 30 with non-migraine headache (NM), and 22 non-headache (NH) age-matched controls. Short-term therapeutic response was measured for at least 2 weeks after the start of therapy. Responders were defined with >50% headache reduction. Plasma CGRP concentrations were measured by ELISA. Results: In the migraine group, more patients required acute therapy, as compared to the NM group (62/68, 91% vs. 5/30, 15%, p = 0.001). The mean plasma CGRP level in migraineurs either during (291 ± 60 pg/ml) or between (240 ± 48) attacks was higher than in NM patients (51 ± 5 pg/ml, p = 0.006 and 0.018, respectively) and NH controls (53 ± 6 pg/ml, p = 0.016 and 0.045, respectively). Forty-seven patients (69%) needed preventive treatments and had higher plasma CGRP levels (364 ± 62 pg/ml, n = 47) than those not (183 ± 54 pg/ml, n = 21) (p = 0.031). Topiramate responders had higher plasma CGRP levels than non-responders (437 ± 131 pg/ml, n = 14 vs. 67 ± 19 pg/ml, n = 6, p = 0.021). Survival curves of plasma CGRP levels also showed those with higher CGRP levels responded better to topiramate. Differences were not found in the other preventives. Conclusion: The plasma CGRP level can differentiate migraine from non-migraine headache. It may also serve as a reference for the therapeutic strategy since it is higher in patients requiring migraine prevention and responsive to short-term topiramate treatment. These results are clinically significant, especially for the young children who cannot clearly describe their headache symptoms and may provide new insights into the clinical practice for the diagnosis and treatment of pediatric migraine.
Study site: Paediatric outpatient clinic,National Taiwan University Hospital (NTUH), Taiwan

Matched MeSH terms: Migraine Disorders
Fulltext Impact of migraine on workplace productivity and monetary loss: a study of employees in banking sector in Malaysia

Wong LP, Alias H, Bhoo-Pathy N, Chung I, Chong YC, Kalra S, et al.

J Headache Pain, 2020 Jun 08;21(1):68.
PMID: 32513174 DOI: 10.1186/s10194-020-01144-z

BACKGROUND/OBJECTIVE: Productivity and monetary loss due to migraine in the workplace may be substantial. This study aimed to determine the impact of migraine on productivity and monetary lost among employees in the banking sectors, in a multiethnic middle income country.
METHODS: A cross-sectional online survey was conducted among employees in two multinational banks in Malaysia between April and July 2019. Screening for migraine was conducted using the self-administered ID-Migraine™ questionnaire. Migraine-related disability (MIDAS) and headache frequency were recorded. Impact of migraine on work productivity and activities were evaluated using the Work Productivity and Activity Impairment (WPAI) questionnaire.
RESULTS: Of the 1268 employees who submitted complete responses, 47.2% (n = 598) were screened positive for migraine. Strikingly, the mean percent productivity loss at work (presenteeism) was almost 20-fold higher than the mean percent work time missed due to migraine (absenteeism) (39.1% versus 1.9%). The mean percent productivity loss in regular activity (activity impairment) and overall work productivity loss (work impairment) was 38.4% and 39.9%, respectively. It was also found that the costs related to presenteeism (MYR 5392.6) (US$1296) was 3.5-fold higher than absenteeism (MYR1,548.3) (US$370). Highest monetary loss related to presenteeism was reported in migraineurs with frequency of headache of above 3 days (MYR 25,691.2) (US$6176), whereas highest monetary loss related to absenteeism was reported in migraineurs with MIDAS grade IV (MYR 12,369.1) (US$2973). Only 30% of migraineurs of MIDAS grade IV reported taking prescribed medication. Notably, a vast majority (96%) of migraineurs who had three or lower episodes of migraine per month did not seek treatment.
CONCLUSION: The significant impact of migraine on work productivity and regular activity, appears to lead to substantial monetary loss attributed to not only absenteeism, but more importantly to presenteeism. This study also highlights the unmet needs in migraine management among employees in the banking sector.

Matched MeSH terms: Migraine Disorders/economics*; Migraine Disorders/epidemiology*; Migraine Disorders/therapy
Fulltext Validity and reliability of the Bahasa Melayu version of the Migraine Disability Assessment questionnaire

Shaik MM, Hassan NB, Tan HL, Bhaskar S, Gan SH

Biomed Res Int, 2014;2014:435856.
PMID: 25121099 DOI: 10.1155/2014/435856

BACKGROUND: The study was designed to determine the validity and reliability of the Bahasa Melayu version (MIDAS-M) of the Migraine Disability Assessment (MIDAS) questionnaire.
METHODS: Patients having migraine for more than six months attending the Neurology Clinic, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia, were recruited. Standard forward and back translation procedures were used to translate and adapt the MIDAS questionnaire to produce the Bahasa Melayu version. The translated Malay version was tested for face and content validity. Validity and reliability testing were further conducted with 100 migraine patients (1st administration) followed by a retesting session 21 days later (2nd administration).
RESULTS: A total of 100 patients between 15 and 60 years of age were recruited. The majority of the patients were single (66%) and students (46%). Cronbach's alpha values were 0.84 (1st administration) and 0.80 (2nd administration). The test-retest reliability for the total MIDAS score was 0.73, indicating that the MIDAS-M questionnaire is stable; for the five disability questions, the test-retest values ranged from 0.77 to 0.87.
CONCLUSION: The MIDAS-M questionnaire is comparable with the original English version in terms of validity and reliability and may be used for the assessment of migraine in clinical settings.

Matched MeSH terms: Migraine Disorders/diagnosis*
Fulltext Migraine: epidemiological aspects of 17 Malaysian patients

Kam CS

Med J Malaysia, 1980 Mar;34(3):221-5.
PMID: 7412662

This is a report of migraine from Malaysia. 17 migraineurs are studied with respect to age, sex, ethnic group, occupation, age of onset, length of disease,' precipitating factors, relieving factors and family history. Similarities and differences between Malaysians and Caucasians are discussed.
Study site: Neurology clinic, Hospital Kuala Lumpur, Malaysia

Matched MeSH terms: Migraine Disorders/etiology*
Fulltext The coexistence of anxiety and depressive personality traits in migraine

Tan HJ, Suganthi C, Dhachayani S, Rizal AM, Raymond AA

Singapore Med J, 2007 Apr;48(4):307-10.
PMID: 17384877

Migraine is associated with a variety of personality traits. The objective of this study was to reevaluate the personality traits using Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in migraine patients diagnosed by applying the new International Classification of Headache Disorders-2 criteria.

Matched MeSH terms: Migraine Disorders/psychology*
Fulltext Complicated migraine--a review of ten cases

Loh TG, Chawla JC

Singapore Med J, 1972 Dec;13(6):298-304.
PMID: 4657200

Complicated migraine is not well known. It is associated with transient and protean sensory and motor
nenrological features although disturbance of mood, affect and psyche has also been described.
This paper is based on a study of ten patients suffering from complicated migraine and attempt is made
to describe various neurological symptoms and signs.
It becomes apparent from this study that there arc diverse manifestations of this interesting disorder.
Furthermore complicated migraine seems to affect a younger age group and there may not be any
family history of migraine. In most cases the nenrological symptoms precede the attacks of headaches.
The nenrological deficit may persist after longer periods. Initially, the attacks arc usnally followed by
complete recovery, with repeated attacks there may be residual neurological deficit. Though the exact
aetiology of the migraine remains unknown, it has been suggested that it is due to spasm or oedema of
cerebral vascular system. If the vessels involved are the carotid artery system, the symptoms and signs
obviously would be due to involvement of cerebral hemisphere, whereas affection of basilar artery
would produce signs and symptoms of cerebellar or brain stem deficiency.
At times it may be extremely difficult to differentiate between a typical attack of migraine and headache
due to an underlying pathology e.g. intracranial angioma or space occupying lesions, which may
require investigations such as angiography. The angiography may prove fruitless and cause deterioration
in neurological signs. A careful follow-up should be planned for cases with complicated migraine
to exclude any underlying pathology.

Matched MeSH terms: Migraine Disorders*
Fulltext Migraine masquerading as temporomandibular disorders: a case report

Shoji Y, Cohen HV

Journal of Clinical and Health Sciences, 2018;3(1):43-46.
MyJurnal

Migraine is a common disabling primary headache disorder. Ipsilateral radiation of pain to orofacial regions, including teeth, jaws and temporomandibular joints, although not a common complaint, could occur. The area of involvement may obscure the diagnosis and lead to unnecessary dental treatment. A case is presented in which a patient initially sought dental care for left jaw pain that radiated to her left maxillary teeth and temple region and she was also experiencing discomfort in the left masticatory musculature. Subsequently a medical consult diagnosed migraine headache without aura and fortunately unnecessary dental treatment was not done. The key issue here is the complexity of the Trigeminal nerve when the dentist is assessing a patient for dental or other orofacial pain complaints and dental pathology has been ruled out. Equally as important is the dentist taking thorough medical history since a patient may not tell a dentist about a “headache” because the pain is in the teeth and/or jaws. And, perhaps most important is the final differential diagnosis whether made by the dentist or medical care provider.

Matched MeSH terms: Migraine Disorders
Fulltext Headache: A study of 50 Malaysian nurses

Tan CT

Family Practitioner, 1982;5(3):61-62.

A study of 50 healthy nurses from the University Hospital showed that 72% had chronic headache. Among those who had chronic headache, 33% were due to migraine. Another 30% were probable migraine subjects and 33% suffered from tension headache. Twenty two nurses had headache more than once a month and 18 nurses described the headache as moderate to severe. The common precipitating factors mentioned were tension, exposure to the sun, lack of sleep and menstruation.

Matched MeSH terms: Migraine Disorders
Fulltext Patent foramen ovale and migraine: what is the relationship between the two?

Sathasivam S, Sathasivam S

J Cardiol, 2013 Apr;61(4):256-9.
PMID: 23484805 DOI: 10.1016/j.jjcc.2012.12.005

There is conflicting evidence on the causal relationship of patent foramen ovale (PFO) in migraine. This review will examine the pathophysiological relevance of PFO in migraine, the epidemiological evidence of PFO causing migraine, and the existing evidence on the effectiveness of closure of PFO on the symptomatology of migraine. From the current available evidence, the role of PFO in migraine is debatable, and interventions such as closure of PFO cannot yet be considered routine treatment of migraine.

Matched MeSH terms: Migraine Disorders/etiology*; Migraine Disorders/therapy
Fulltext Vitamin supplementation as possible prophylactic treatment against migraine with aura and menstrual migraine

Shaik MM, Gan SH

Biomed Res Int, 2015;2015:469529.
PMID: 25815319 DOI: 10.1155/2015/469529

Migraine is the most common form of headache disorder globally. The etiology of migraine is multifactorial, with genetic components and environmental interactions considered to be the main causal factors. Some researchers postulate that deficits in mitochondrial energy reserves can cause migraine or an increase in homocysteine levels can lead to migraine attacks; therefore, vitamins could play a vital role in migraine prevention. For instance, riboflavin influences mitochondrial dysfunction and prevents migraine. Genes such as flavoenzyme 5,10-methylenetetrahydrofolate reductase (MTHFR), especially the C677T variant, have been associated with elevated plasma levels of homocysteine and migraine with aura. Homocysteine catalyzation requires the presence of vitamins B6, B12, and folic acid, which can decrease the severity of migraine with aura, making these vitamins potentially useful prophylactic agents for treating migraine with aura. Menstrual migraine, on the other hand, is associated with increased prostaglandin (PG) levels in the endometrium, indicating a role for vitamin E, which is an anti-PG. Vitamin C can also be used as a scavenger of reactive oxygen species for treating neurogenic inflammation in migraine patients. This paper reviews possible therapies based on vitamin supplementation for migraine prophylaxis, focusing on migraine with aura and menstrual migraine.

Matched MeSH terms: Migraine Disorders/blood; Migraine Disorders/complications; Migraine Disorders/diet therapy*; Migraine Disorders/pathology
Fulltext Quality of life and migraine disability among female migraine patients in a tertiary hospital in Malaysia

Shaik MM, Hassan NB, Tan HL, Gan SH

Biomed Res Int, 2015;2015:523717.
PMID: 25632394 DOI: 10.1155/2015/523717

Disability caused by migraine may be one of the main causes of burden contributing to poor quality of life (QOL) among migraine patients. Thus, this study aimed to measure QOL among migraine sufferers in comparison with healthy controls.

Matched MeSH terms: Migraine Disorders/epidemiology*
Fulltext Platelet alloantigen polymorphism and migraine headaches

Bhaskar S, Abdullah JM

Neurosciences (Riyadh), 2013 Apr;18(2):185-6.
PMID: 23545624
Matched MeSH terms: Migraine Disorders; Migraine Disorders/genetics*
Fulltext Validity and reliability of the Malay version of the Structured Migraine Interview (SMI) Questionnaire

Shaik MM, Hassan NB, Tan HL, Bhaskar S, Gan SH

J Headache Pain, 2015 Mar 14;16:22.
PMID: 25903056 DOI: 10.1186/s10194-015-0509-5

BACKGROUND: The Structured Migraine Interview (SMI) is a valid and reliable instrument for migraine diagnosis. However, a Malay version of the SMI is not available to be applied to the local Malaysian population. This study was designed to access the validity and reliability of a new Malay version of the SMI questionnaire.
METHODS: Patients with headache attending the Neurology Clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia, were screened against the inclusion/exclusion criteria before recruitment. A standard translation procedure was used to translate and adapt the questionnaire into the Malay language. The translated version was tested for face, content and construct validities. Subsequently, validity and reliability studies were conducted (1(st) compilation), followed by retesting seven days later (2(nd) compilation).
RESULTS: A total of 157 patients between 15 and 60 years of age were enrolled in this study. The kappa value was 0.70 (p

Matched MeSH terms: Migraine Disorders/diagnosis*
Fulltext The Use of Pharmacological Preventive Therapy for Migraine With Weight Gain Potential Amid Coronavirus Disease 2019 Pandemic

Kow CS, Hasan SS

Headache, 2020 10;60(9):2085-2086.
PMID: 32790208 DOI: 10.1111/head.13945
Matched MeSH terms: Migraine Disorders*

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