Background and purpose Although migraine is the second most disabling condition worldwide, there is poor awareness of it. The objective was to assess the awareness of migraine and previous diagnostic and therapeutic consultations and treatments in a large international population of migraineurs. Methods This was a multicentre study conducted in 12 headache centres in seven countries. Each centre recruited up to 100 patients referred for a first visit and diagnosed with migraine. Subjects were given a structured clinical questionnaire‐based interview about the perceptions of the type of headache they suffered from, its cause, previous diagnoses, investigations and treatments. Results In all, 1161 patients completed the study. Twenty‐eight per cent of participants were aware that they suffered from migraine. Sixty‐four per cent called their migraine ‘headache'; less commonly they used terms such as ‘cervical pain' (4%), tension headache (3%) and sinusitis (1%). Eight per cent of general practitioners and 35% of specialists (of whom 51% were neurologists and/or headache specialists) consulted for migraine formulated the correct diagnosis. Before participating in the study, 50% of patients had undergone X‐ray, computed tomography and/or magnetic resonance imaging of the cervical spine and 76% underwent brain and/or cervical spine imaging for migraine. Twenty‐eight per cent of patients had received symptomatic migraine‐specific medications and 29% at least one migraine preventive medication. Conclusions Although migraine is a very common disease, poor awareness of it amongst patients and physicians is still an issue in several countries. This highlights the importance of the promotion of migraine awareness to reduce its burden and limit direct and indirect costs and the risk of exposure to useless investigations.

Objectives: Pain experienced in migraine involves the sensitization of trigeminal afferent neurons, but the extraordinary cellular diversity within trigeminal ganglia has limited our understanding of the molecular substrates through which this process occurs. Recent advances in single-cell RNA sequencing technology have enabled the massively parallel identification and molecular profiling of nearly all cells within heterogeneous tissues. We are using this powerful tool to identify unique gene expression patterns within individual trigeminal ganglion cell types, and aim to leverage this insight towards the discovery of fundamentally new targets in headache pathophysiology. Methods: Single-cell RNA sequencing was performed on postmortem mouse and human trigeminal ganglia. Approximately ten thousand cells were collected with a custom-designed microfluidics device (inDrops) and sequenced using next-generation Illumina sequencing. Unsupervised principle component analysis and graph clustering generated groups of cells based on their measured gene expression patterns. Novel marker genes were then identified using gene set enrichment analysis. Results: Bioinformatic analysis of mouse and human data from trigeminal ganglion single-cell RNA sequencing identified clusters of cells that represent neuronal, glial, vascular, and meningeal cell subtypes. Individual cell types are clearly delineated based on their gene expression profiles, which enabled the interrogation of specific subtypes of neurons (e.g. CGRPþ nociceptors) or glia (e.g. satellite glia). Each of these unique cell populations are confirmed by selective expression of known marker genes. After each cell type was determined, genome-wide enrichment analysis was performed to determine the set of genes that are selectively enriched in each cell type. Indeed, we have identified the genes that are highly enriched in both mouse and human CGRPþ neurons. These data establish a new resource for querying the expression level of genes within specific cell types of the mouse and human trigeminal ganglia. Conclusion:The gene expression patterns of individual mouse and human trigeminal ganglia cells were reliably described by single-cell RNA sequencing. These data enabled the discovery of novel genes that are uniquely expressed within specific trigeminal cell subtypes such as CGRPþ neurons. Future studies are aimed at investigating the role of these genes in CGRPþ neuronal function and migraine pathophysiology. Disclosure of Interest: None DeclaredMigraine Acute Therapy OC-LB-002Non Objectives: Pilot studies and clinical experience have suggested the safety, tolerability, and preliminary efficacy of non-invasive vagus nerve stimulation (nVNS; gammaCore Õ ) for the treatment of migraine. nVNS is an attractive option for patients, with its ease of use, flexibility, and favourable adverse event profile. We explored the efficacy, safety, and tolerability of nVNS in the acute treatment of migraine in a multicentre, double-blind, randomised, controlled trial (RCT). Methods: 248 su...

No abstract

The association between memory loss and Hodgkin's lymphoma has been given the eponym of Ophelia syndrome, in memory of Shakespeare's character in The Tragedy of Hamlet, Prince of Denmark. Nevertheless, there are differences between the disease and the character. Objective: To review the origins and uses of the eponym through an original article by pathologist Ian Carr, its relation to the character Ophelia, and the related autoantibodies. Methods: Historical narrative review. Results: Besides an eloquent description in the original article, Carr presaged the presence of autoantibodies, before they had been thoroughly researched. Since then, five different autoantibodies (mGluR5, Hu, NMDAR, SOX, PCA2) have been associated with Hodgkin's disease. It is interesting to note the divergent outcomes of Shakespeare's character and the patient in the original description by Carr, the latter recovering to lead a normal life, and the former deceased. Conclusions: Although there is little relationship between the fictional character and the syndrome, both imply the unintentional trigger of self-harm (suicide in one case, autoimmunity in the other), thus remaining associated.

The coronavirus (COVID-19) pandemic, confinement, fear, lifestyle changes, and worldwide health care impacted almost all diseases. Reports from countries outside Latin America revealed differences in migraine patients. In this study, we describe and compare the immediate changes in migraine symptoms associated with COVID-19 quarantine in patients from Argentina, Mexico, and Peru. An online survey was conducted from May to July 2020. The survey was answered by 243 migraine patients, with questions related to sociodemographic data, quarantine conditions, changes in working conditions, physical activity, coffee intake, healthcare access, acute migraine medication use, symptoms of anxiety, depression, and fear of COVID-19. The results show that 48.6% of migraine patients experienced worsened symptoms, 15.6% improved, and 35.8% remained unchanged. Worsening migraine symptoms were associated with staying at home during the lockdown. Intake of analgesics was associated with an increase in migraine symptoms of 18 times relative to those who did not increase their intake. Migraine symptoms improved when the number of sleep hours was increased, and we observed an improvement when patients decreased analgesic intake. The uncertainty about the end of the pandemic, the news, and social media are three items that contributed to the worsening of migraine symptoms in patients in the three investigated countries. Confinement during the first pandemic wave in Latin America harmed migraine patients who stayed home during the lockdown.