Cortical Excitability in Chronic Migraine

Coppola, Gianluca; Schoenen, Jean

doi:10.1007/s11916-011-0231-1

Cited by 101 publications

(84 citation statements)

References 49 publications

(61 reference statements)

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“…Interestingly, quantitative electromyography (EMG) recordings in 23 chronic migraine patients during eTNS with the Cefaly ® showed an increase of median frequency and amplitude of the myoelectrical signal in anterior temporalis, auricularis posterior, and middle trapezius muscles, but not in frontalis (37). The significance of this finding for the mode of action of the device is doubtful, the more so that it is unlikely that pericranial muscle activity plays a pathogenic role in chronic migraine (38).…”

Section: Peripheral Mechanismsmentioning

confidence: 98%

Migraine treatment with external trigeminal nerve stimulation: current knowledge on mechanisms

Schoenen

2017

IMRJ

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Section: Peripheral Mechanismsmentioning

confidence: 98%

Migraine treatment with external trigeminal nerve stimulation: current knowledge on mechanisms

Schoenen

2017

IMRJ

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“…Interestingly, all these mechanisms might be involved in the process of headache chronification. In particular, enhanced activation of the central glutaminergic system might be responsible of an increased cortical excitability [25]; in addiction, repeated morphine administration has also been shown to increase levels of pro-nociceptive peptides, as calcitonin generelated peptide (CGRP) and substance P, within the dorsal root ganglia in animal studies [26,27]. Enhanced levels of CGRP and substance P might be present in dural afferents of trigeminal ganglia in migraine patients assuming opioids.…”

mentioning

confidence: 99%

Controversies in migraine treatment: opioids should be avoided

Casucci¹,

Cevoli

2013

Neurol Sci

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The use of opioids for migraine is still controversial. Evidence-based guidelines do not recommend opioids as first-line treatment of migraine attacks, while clinical and epidemiological surveys demonstrate that the use of opioids is associated with more severe headacherelated disability, symptomology and comorbidities, and greater health-care resource utilization. There are concerns that opioids may be misused or abused, leading to opioid abuse or dependence and migraineurs are particularly prone and at risk for the development of chronic daily headache from opioids overuse. Since clinical and preclinical studies evidence a pathophysiological role of opioids in migraine progression, opioids should be avoided in migraine patients.The role of opioids in clinical practice for migraine: the state-of-the-art Migraine is a common disabling neurologic disorder, characterized by recurrent headache attacks manifesting with unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity, and association with nausea and/or photophobia and phonophobia [1]. The goals of acute migraine treatments are to treat attacks rapidly and consistently without recurrence, restore the patient's ability to function, minimize the use of back-up and rescue medications, optimize self-care and reduce subsequent use of resources, be cost-effective for overall management, and have minimal or no adverse events [2]. Acute treatments used for migraine include nonspecific agents such as aspirin, acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and barbiturates among others, as well as migraine-specific medications, including ergot alkaloids and triptans [2]. International guidelines recommend triptans and NSAIDs as first-line treatment of migraine attacks [2][3][4]. Use of opioids for treatment of migraine is controversial. Despite evidence-based guidelines do not recommend opioids as first-line treatment of migraine attacks [2][3][4], and no randomized controlled trial has shown any significant effect of opioids on migraine attacks when pain-free was the primary end-point of the study [5], their use in clinical practice [6][7][8] and, even more, in emergency departments (EDs) is very large, especially in USA and Canada [9,10]. Moreover, among studies about the efficacy of opioids as rescue medication for acute migraine in EDs recently revised, only one evidenced a superiority of meperidina 75 mg i.m. versus ketorolac 30 mg i.m., three reported superiority of competitors and eight reported similar results for opioids versus competitors such as DHE, metoclopramide, chlorpromazine, droperidol, and ketorolac [5]. In any case, opioids did not adequately restore the patient's ability to function. The negative impact of opioids on migrainous population is reported in several clinical and epidemiological studies. In fact, opioids use for migraine resulted associated with more severe headache-related disability, symptomology, and comorbidities (primarily, psychiatric, and cardi...

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“…PD power was also significantly superior in episodic migraine as compared to chronic migraine. This could be related to the changes in visual cortex responsiveness over the migraine cycle [20,22] and between episodic and chronic migraine [23]. For instance, during stimulus repetition, EEG and magnetoencephalographic visual evoked responses lack habituation in episodic migraine between attacks, but habituate normally during attacks and in chronic migraine [24,25,26].…”

Section: Discussionmentioning

confidence: 99%

“…For instance, during stimulus repetition, EEG and magnetoencephalographic visual evoked responses lack habituation in episodic migraine between attacks, but habituate normally during attacks and in chronic migraine [24,25,26]. Since the response pattern in chronic migraine is indistinguishable from that found during attacks in episodic migraine, it was suggested that chronic migraine patients are locked in an "ictal-like state" [23,27]. Patients with a high attack frequency are at greater risk of being recorded close to an attack than those with a low number of monthly attacks.…”

Section: Discussionmentioning

confidence: 99%

Analysis and clinical correlates of 20 Hz photic driving on routine EEG in migraine

et al. 2014

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Abstract:Enhanced photic driving (PD) during high frequency flicker stimulation, the so-called H response, is a classical feature of migraine patients between attacks, but is thought to be of poor clinical utility. Visual inspection of the EEG for its detection may not be reliable, however, and data on its possible correlations with clinical features and migraine pathophysiology are scarce.We have compared visual inspection and EEG spectral analysis to detect abnormal PD in 280 consecutive migraine patients of our headache clinic (episodic migraine without aura, n=171; chronic migraine, n=48; migraine with aura, n=61) and in a group of 24 non-migrainous neurological controls. Spectral frequency analyses were performed blindly by one of us (YF). On visual inspection, 50.4% of migraineurs were thought to have increased 20Hz PD. After spectral analysis, only 62.4% of them had PD power superior to the mean+95%CI of the control group. Sensitivity of visually identified PD was 82.24%, specificity 69.36%. Increased PD on spectral analysis was more prevalent in episodic migraine than in chronic migraine, in patients with low attack frequency, in those with ictal autonomic symptoms in addition to nausea and in those with a strong family history of migraine. We confirm therefore that 20Hz photic driving is of little diagnostic utility and its prevalence in migraine overestimated on visual inspection. Its presence on spectral analysis of the EEG, however, might be of pathophysiological interest, as it identifies subgroups of migraineurs of whom the common denominator could be lack of habituation of cortical responses during repetitive stimulation. We have compared visual inspection and EEG spectral analysis to detect abnormal PD in 280 consecutive migraine patients of our headache clinic (episodic migraine without aura, n=171; chronic migraine, n=48; migraine with aura, n=61) and in a group of 24 non-migrainous neurological controls. Spectral frequency analyses were performed blindly by one of us (YF).On visual inspection, 50.4% of migraineurs were thought to have increased 20Hz PD. After spectral analysis, only 62.4% of them had PD power superior to the mean+95%CI of the control group. Sensitivity of visually identified PD was 82.24%, specificity 69.36%.Increased PD on spectral analysis was more prevalent in episodic migraine than in chronic migraine, in patients with low attack frequency, in those with ictal autonomic symptoms in addition to nausea and in those with a strong family history of migraine.We confirm therefore that 20Hz photic driving is of little diagnostic utility and its prevalence in migraine overestimated on visual inspection. Its presence on spectral analysis of the EEG, however, might be of pathophysiological interest, as it identifies subgroups of migraineurs of whom the common denominator could be lack of habituation of cortical responses during repetitive stimulation.

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Cortical Excitability in Chronic Migraine

Cited by 101 publications

References 49 publications

Migraine treatment with external trigeminal nerve stimulation: current knowledge on mechanisms

Migraine treatment with external trigeminal nerve stimulation: current knowledge on mechanisms

Controversies in migraine treatment: opioids should be avoided

Analysis and clinical correlates of 20 Hz photic driving on routine EEG in migraine

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