Background: Migraine pain location and trigeminocervical convergence have limited diagnostic value and have usually been assessed using non-standard verbal descriptors in a small number of centers. Objective: To use non-verbal descriptors of migraine pain location to determine the prevalence of trigeminocervical convergence mechanisms in patients with episodic and chronic migraine. In addition, we explored the factors associated with the presence of convergence. Methods: A multicenter study was carried out. The explicit pain location was explored by asking subjects to indicate, on an electronic form, three points on the anterolateral side and three points on the posterolateral side of the head and neck that represented the common locations of their migraine pain. We evaluated associations of the pain pattern with demographic and psychological features, comorbidities, lifestyle and other headache characteristics. Results: 97 episodic and 113 chronic migraine patients were included. Convergence was present in 116 migraineurs (55%) who indicated dominance of pain in the posterior cervical region. This site was more often involved in the chronic migraine group (21 vs. 33%; p=0.034). The number of migrainous/altered sensitivity symptoms (OR=1.39; 95%CI 1.14–1.71) was associated with convergence independently of the chronification status. In this symptom group, there were statistical associations between convergence and vomiting (p=0.045), tactile allodynia (p<0.001), nuchal rigidity (p<0.001) and movement allodynia (p=0.031). Conclusions: Trigeminocervical convergence is common in migraineurs and, in practice, it might be found frequently in chronic migraineurs. Some features commonly found in this group, such as altered sensitivity symptoms, are associated with this phenomenon.

Introduction: When migraine evolves from episodic to chronic form, it becomes more disabling, due to refractory treatment and the arising of comorbidities. Bruxism has already been associated with migraine in adults, with a bidirectional relationship between sleep bruxism and chronic migraine. This study aimed to assess whether sleep and wake bruxism are more prevalent in chronic migraine when compared to episodic migraine and also to establish possible clinical correlations with chronification. Methods: 210 patients were allocated to the study, 97 with episodic migraine (EM) and 113 with chronic migraine (CM). The patients were submitted to face-to-face interviews with a neurologist to confirm the diagnosis and fill in the scales: specific questionnaire for the diagnosis of sleep and wake bruxism, PHQ-9 (depression), GAD-7 (anxiety), Epworth Scale (sleepness), MIDAS and HIT-6 scales to assess the migraine disability and the headache impact on patients. Results: The prevalence of sleep and wake bruxism was similar in patients with EM versus CM (p=0.300 and p=0.238). The correlation of patients with both bruxism forms at the same time with the high scores on the migraine disability and the headache impact, was higher among patients with chronic migraine than in patients with chronic migraine. episodic migraine (p <0.001). Conclusion: Sleep and wake bruxism alone aren’t more prevalent in chronic migraine when compared to episodic migraine. In patients affected with both bruxism forms, bruxism only causes a greater impact and disability on individuals with chronic migraine.

IntroductionWhen migraine undergoes transformation from episodic to chronic form it becomes more disabling due to the refractoriness in treatment and the emergence of comorbidities, with the establishment of a bidirectional relationship between sleep bruxism and chronic migraine. This study aimed to assess whether sleep and awake bruxism are more prevalent in chronic migraine when compared to episodic migraine and also to establish possible clinical correlations with the process of chronification.Methods210 patients were allocated to the study, 97 with episodic migraine and 113 with chronic migraine, who underwent face-to-face interviews with the completion of the scales: specific questionnaire for the diagnosis of sleep and awake bruxism, PHQ-9 (depression), GAD-7 (anxiety), Epworth Scale (daytime sleepiness), MIDAS (migraine incapacity) and HIT-6 (impact of headache). ResultsThe prevalence of sleep and awake bruxism was similar in patients with episodic versus chronic migraine (p = 0.300 and p = 0.238). The correlation of patients with concomitant awake and sleep bruxism and with high scores on the migraine incapacity (MIDAS) and headache impact (HIT-6) scales was higher among patients with chronic migraine than in patients with episodic migraine. (p <0.001 and p <0.001). ConclusionSleep and awake bruxism alone are not more prevalent in chronic migraine when compared to episodic migraine, although bruxism causes greater impact and disability on individuals with chronic migraine.

Background: The pain location of migraine has limited diagnostic value and has usually been assessed using non-standard verbal descriptors.Methods: This study uses non-verbal descriptors of pain location in episodic and chronic migraineurs seen at 3 centers of different complexities (tertiary-level hospital and outpatient clinics) and from different sectors (public and private). The explicit pain location was recorded by asking patients to indicate in an electronic form 3 points on the anterolateral side and 3 points on the posterolateral side of the head and neck. A multivariate logistic regression model was fitted to assess the association of different pain location patterns with demographic and clinical variables.Results: Ninety-seven episodic migraine and 113 chronic migraine patients were included, with the most commonly affected sites being the frontal (73% and 65%, respectively), temporal (67% and 73%, respectively) and parietal (27% and 34%, respectively) regions. The posterior cervical site was most often involved in the chronic migraine group (21% vs. 33%, p=0.034). No other locations showed a significant difference. The adjusted model showed that diffuse pain (OR=13.74, CI=4.89-49.85) and the presence of medication overuse associated with tactile allodynia (OR=2.65, CI=1.05-6.87) were associated with increased odds of neck pain. Disease duration was marginally relevant (p=0.078).Conclusions: The migraine attacks most commonly involve the fronto-temporal regions, although neck pain can be more often found in chronic migraine. Some features commonly found in this group such as more diffuse pain, tactile allodynia, and medication overuse are associated with this extratrigeminal site of pain.

IntroductionMigraine with aura is less frequent than the subtype form without aura. Normally, auras are typically manifested visual symptoms, but it is possible to have an auditory and olfactory complains as aura symptomatology.Case reportAn 8-year-old boy with family cases of migraine, complained of auditory hallucination episodes, since he was 5 years-old, with a duration of 10 to 20 minutes, followed by cure with intense photophobia and nausea. He called these episodes as "sound attacks". The frequency of the crises ranges from 4 to 5 episodes per month, with the maximum of 11 episodes in one month.Neurological examination was normal. He performed angio-MRI of skull and EEG, without any changes. Treatment was initiated with 250 mg sodium divalproate at night with reduction of events, already in the first month, for 2 to 3 episodes per month. The medication was adjusted for 500 mg of sodium divalproate with a good result, not presenting new episodes in the last 2 months.ConclusionWe report a case of migraine crises preceded by auditory aura, in a boy of 8 years. This is a rare and extremely interesting presentation of migraine, with great improvement after the prophylactic treatment.