Bakgrund: Migrän och huvudvärk av spänningstyp (HST) är två vanligt förekommande hälsoproblem. Traditionellt behandlas dessa åkommor farmakologiskt men på senare tid har fysioterapeutisk behandling blivit allt vanligare. Aerob träning är en av många fysioterapeutiska behandlingsmetoder som kan verka smärtlindrande för dessa patienter. Syfte: Att undersöka effekten av aerob träning på upplevd smärtnivå för personer med migrän och/eller HST. Metod: Studiens design var litteraturstudie. Systematiska sökningar genomfördes i databaserna PubMed och PEDro. Sökresultatet granskades utefter urvalskriterierna. Inkluderade artiklars risk för snedvridning bedömdes utifrån PEDro granskningsmall och det sammanvägda resultatets tillförlitlighet utvärderades med hjälp av GRADEstud. Resultat: Efter urvalsprocessen inkluderades åtta randomiserade kontrollerade studier. En av artiklarna bedömdes ha hög kvalitet och resterande hade måttlig kvalitet. Inkluderade artiklars olikheter gällande intervention och population ledde till subgruppering av resultaten. Antal dagar med migrän per månad minskade inom samtliga grupper som hade aerob träning som intervention men mellangruppsjämförelserna var ej statistiskt signifikanta. Samma minskning gick inte att se gällande HST. Den sammanvägda tillförlitligheten utifrån GRADEstud bedömdes som låg eller mycket låg gällande alla subgrupper. Konklusion: Baserat på artiklarnas resultat, låga kvalitet och det sammanvägda resultatets låga tillförlitlighet kan inga säkra slutsatser dras gällande effekten av aerob träning på upplevd smärtnivå för personer med migrän och HST. Fler studier behövs. / Background: Migraine and tension-type headache (TTH) are two common health problems. These health problems are traditionally treated pharmacologically but physical therapy has lately gained popularity as a treatment option. Aerobic exercise is one of many physiotherapeutic treatments that can reduce pain for these patients. Purpose: To examine the effect of aerobic exercise on perceived pain level for individuals with migraine and/or TTH. Method: The study design was literature review. Systematic searches were performed in the databases PubMed and PEDro. The search result was reviewed according to the selection criteria. The risk of bias in the included articles was assessed using PEDro scale and the certainty in evidence of the articles summarized outcomes was assessed using GRADEstud.  Results: Eight randomized controlled studies were included after the selection process. One article was considered to have high quality and the remaining seven to have fair quality. The results were sub-grouped due to differences in the included articles regarding intervention and population. Number of days with migraine per month decreased within all groups with training as intervention but the between group comparisons were not statically significant. The same reduction could not be found regarding TTH. The certainty in evidence of the articles summarized outcomes was considered to be low or very low in all subgroups. Conclusion: No certain conclusion could be drawn regarding the effect of aerobic exercise on perceived pain level in individuals with migraine and TTH based on the articles results, low quality, and low certainty in evidence. More studies are needed.

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Consumption loans has increased considerably during 2010-2019 and thus affected householddebt and financial stability due to high interest rates with short maturity. To investigate thesubject multiple neoclassical models has been used additional to a regression analysis with adequate variables and descriptive diagrams. Mental health has seemingly worsened from 2010and onwards, so we want to investigate whether it’s due to rising debt levels or not. For that we investigate the variables anxiety, depression, and migraine for the mental health parameter. In this thesis we want to analyze whether there is a causal relationship between debt and mentalhealth between 2010 and 2019. The main conclusion is that there are some correlations between debt and mental health for females 25-54 and 55-64 years old. Females 18-25 years old had a negative correlation between debt and mental health. Likewise did males in all age categories. For males 55-64 years old a strong correlation between unemployment and mental health issues was found. No causal relationship between debt and mental health issues can be established inthis paper due to inexplicit correlations.

No / Two different theories of migraine aura exist: In the vascular theory of Wolff, intracerebral vasoconstriction causes migraine aura via energy deficiency, whereas in the neuronal theory of Leão and Morison, spreading depression (SD) initiates the aura. Recently, it has been shown that the cerebrovascular constrictor endothelin-1 (ET-1) elicits SD when applied to the cortical surface, a finding that could provide a bridge between the vascular and the neuronal theories of migraine aura. Several arguments support the notion that ET-1¿induced SD results from local vasoconstriction, but definite proof is missing. If ET-1 induces SD via vasoconstriction/ischemia, then neuronal damage is likely to occur, contrasting with the fact that SD in the otherwise normal cortex is not associated with any lesion. To test this hypothesis, we have performed a comprehensive histologic study of the effects of ET-1 when applied topically to the cerebral cortex of halothane-anesthetized rats. Our assessment included histologic stainings and immunohistochemistry for glial fibrillary acidic protein, heat shock protein 70, and transferase dUTP nick-end labeling assay. During ET-1 application, we recorded (i) subarachnoid direct current (DC) electroencephalogram, (ii) local cerebral blood flow by laser-Doppler flowmetry, and (iii) changes of oxyhemoglobin and deoxyhemoglobin by spectroscopy. At an ET-1 concentration of 1 µM, at which only 6 of 12 animals generated SD, a microarea with selective neuronal death was found only in those animals demonstrating SD. In another five selected animals, which had not shown SD in response to ET-1, SD was triggered at a second cranial window by KCl and propagated from there to the window exposed to ET-1. This treatment also resulted in a microarea of neuronal damage. In contrast, SD invading from outside did not induce neuronal damage in the absence of ET-1 (n = 4) or in the presence of ET-1 if ET-1 was coapplied with BQ-123, an ETA receptor antagonist (n = 4). In conclusion, SD in presence of ET-1 induced a microarea of selective neuronal necrosis no matter where the SD originated. This effect of ET-1 appears to be mediated by the ETA receptor.

Migraine is a complex neurovascular disorder of the brain characterized by episodes of severe head pain and dysfunction of the autonomic nervous system with or without aura. Migraine affects nearly 324 million people worldwide and causes severe disability in women during the most productive years of life. The World Health Organization considers severe migraine to be as disabling as quadriplegia and terminal stage cancer. Healthcare professionals often perceive migraine headaches as minor complaints, resulting in poorly acknowledged physical, emotional, and economic burdens contributing to diminished quality of life in women with migraine disorder. Approximately 10 million people suffer from migraines in the United States, yet evidence suggests that management of migraine is suboptimal. The purpose of the thesis is to educate healthcare professionals on the screening, diagnosis, and treatment of migraine disorders to enhance care of patients and improve quality of life. An interdisciplinary review of research was completed using the online databases Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE- EBSCOhost, Academic Search Premier, and PubMed. Findings concluded that migraines impact quality of life in the physical, psychological, social, and spiritual dimensions of well-being. Nursing implications for improving migraine management and quality of life include advocating for clients with migraines, seeking continuous education in regards to migraine management, educating clients and their families about managing migraines, and competently caring for clients with migraines.

Chronic migraines are a neurological disorder, which can be debilitating to patients and result in increased healthcare costs and disability-affected life years. Botox and CGRP antagonists are two drugs used as prophylactic treatments for chronic migraine patients who have failed other medications in the past. However, there are currently no studies that have directly compared the two drugs and existing research indirectly comparing them has had conflicting conclusions regarding efficacy. This double-blind, prospective clinical study aims to determine whether there is a clinically significant difference in efficacy between the two drugs defined as percent reduction in headache days per month. Patients will be recruited and divided into three groups: those who will receive Botox injections, those who will receive Emgality injections, and placebo. The results of this study will be analyzed with ANOVA to determine whether there is a statistically significant difference among the groups, then further analyzed with paired T-tests to determine if one treatment is superior to the other. These results could be used for further research into migraine treatments, as well as to help determine which treatment to trial first in patients with migraines refractory to other medications.

Une revue de la littérature a révélé que les attentes d'efficacité personnelle sont significativement associées à la perception de la douleur et permettent de prédire de façon significative les réponses des patient-e-s au traitement de la douleur. La présente étude visait à évaluer le rôle de 11 efficacité personnelle lors du traitement des migraines à l'aide de la biorétroaction thermique. Vingt-sept femmes souffrant de migraines ont été assignées aléatoirement à l'une des deux conditions expérimentales. Des graphiques falsifiés générés par ordinateur suggéraient que les sujets montraient soit des habiletés supérieures (condition à succès élevé) ou inférieures (condition à succès modéré) pour le réchauffement des mains comparativement à un échantillon normatif fictif de patients souffrant de migraines. Bien que la manipulation du succès perçu ait produit des différences significatives entre les groupes quant aux attentes d'efficacité personnelle, ces groupes n'ont montré aucune réduction significativement différente de 1'activitémigraineuse ou de la prise de médicaments.

La migraine est un désordre neurovasculaire caractérisé par des crises récurrentes de céphalée accompagnées de troubles neurologiques variables dont l'allodynie cutanée.Chez un petit nombre de patients, la migraine passe du stade épisiodique au stade chronique, ou transformation migraineuse. Des études cliniques indiquent que la prévalence de troubles psychiatriques( anxiété/dépression) est plus élevé chez les migraineux chronique que chez le migraineux épisodique. Cependant des telles études ne permettent pas de déterminer le lien de causalité. Le but de ce travail est d'étudier le rôle de la répétition des crises de migraine sur l'apparition d'un état anxio-dépressif et ses mécanismes. Cette étude a été réalisée dans un modèle de migraine chez le rat : injections répétées de soupe inflammatoire (SI) au niveau des méninges.[...]Ces résultats suggèrent que l'apparition de troubles anxio-dépressifs chez le migraineux chronique est une conséquence directe de la répétition des crises. Cette anxiété résulte, entres autres, d'une sensiblisation du MeA impliquant les canaux ASICS1a. Ainsi élucider les mécanismes impliqués dans l'apparition de troubles anxio-dépressifs doit aider à comprendre la transformation migraineuse et améliorer son traitement. / Migraine is a common episode neurovascular disorder that manifest as reccurent attacks of severe headache together with variable neurological symptômes such as cutaneous allodyna. In subgroup of patients, attack frequency increases over time leading to chronic migraine. Clinical studies indicate that patients with episodic migraine are more likely to have anxiety symptoms than patients with episodic migraine..However, in cross-sectional studies, it is not possible to disentangle causal sequence. Our aim is to assess the role oh headache repetition on anxiety/depression symptoms. We use a rat model of migraine : stimulation of meningeal nociceptors by injecting an inflammatory soup (SI)[...]Such anxiety is due, at least in part, to MeA, sensitization involving ASIC1a channels. Dissecting out the mechanisms of the appearance of anxiety/depression symptoms following repeated migraine attacks in thus helping to understand migraine transformation and in turn to improve therapy.

La migraine constitue un problème de santé publique ayant un impact négatif majeur dans la vie quotidienne des patients. Douze pour cent de la population mondiale souffre de migraine et son coût est évalué à 18 milliards d'euros par an dans la communauté européenne. La fréquence des crises peut augmenter au cours du temps chez certains migraineux, faisant ainsi évoluer une migraine épisodique (0 à 14 jours de crises par mois) en migraine chronique (plus de 15 jours de crises par mois). Ce processus est qualifié de transformation de la migraine. La fréquence des crises semble être un facteur important dans ce processus. Utilisant des approches comportementales, électrophysiologiques, immunohistologiques(expression de la protéine Fos), nous avons identifié une partie des mécanismes neurobiologiques impliqués dans la transformation des céphalées. En effet, en développant un modèle animal de stimulation chimique répétée des méninges nous avons évalué (1) le rôle de l'intensité et de lafréquence sur la sensibilité cutanée (2) la sensibilisation des neurones de la corne dorsale spinale et trigéminale (3) l'efficacité du traitement de fond de référence de la crise, le propranolol (4) l’implication du tronc cérébral (le locus coeruleus (LC) et la substance grise periacqueducale (PAG)) dans la sensibilisation des neurones trigéminaux et spinaux (5) l'implication du LC dans les modifications de la sensibilité cutanée induite par la stimulation chimique des méninges. Notre étude comportementale révèle que la topographie (céphalique et/ou extracéphalique) et la nature (statique ou dynamique) de l'allodynie induite par la stimulation chimique des méninges est sous l'influence de deux facteurs : l'intensité et la fréquence de la stimulation, qui peuvent entraîner sa persistance. Nos études électrophysiologiques et comportementales confirment que l'allodynie cutanée céphalique et extracéphalique est le reflet de la sensibilisation des neurones trigéminaux cervicaux et spinaux, qui peut devenir persistante. Le propranolol, permet de prévenir la modification de la sensibilité cutanée ainsi que l'altération de l'activité des neurones trigéminaux et spinaux. Nous avons également observé la sensibilisation de deux structures du tronc cérébral : la PAG et la PAG qui se traduisent par une altération persistante des CIDN. Cependant le propranolol semble prévenir l'altération de tous ces phénomènes via l'inhibition d'une seule structure le LC et non la PAG. En effet, nos microinjections de propranolol dans le LC permettent de prévenir toutes les modifications induites par la stimulation chimique des méninges. En conclusion ces résultats suggèrent que la fréquence et l'intensité des crises de migraine sont deux facteurs de risque endogène de transformation des céphalées. Un marqueur de cettetransformation est l'allodynie, qui est le reflet clinique de la sensibilisation centrale des neurones de la corne dorsale. Cette sensibilisation centrale est due à l'arrivée directe d'information provenant des méninges mais également à une altération de l'activité neuronale du LC. Nous pouvons également dire que le propranolol constitue un excellent choix dans le traitement de la crise migraineuse étant donné qu'il prévient toutes les modifications induites par la stimulation chimique des méninges et qu'il agit via le LC. / Migraine is a public health problem having a major negative impact on the daily lives of patients. Twelve percent of the world population suffers from migraine and its cost is estimated at $ 18 billion per year in the European Community. The frequency of attacks may increase over time in some migraineurs, thus evolve episodic migraine (0-14 days crises by month) in chronic migraine (more than 15 days of attacks by month). This process is called transformation of migraine. Frequency of headache attacks at baseline appears to be an important risk factor for this process. Using behavioral electrophysiological, and immunohistochemical (expression of Fos protein) approaches, we have identified some of the neurobiological mechanisms involved in the transformation of migraine. Indeed, developing an animal model of repeated chemical stimulation of the dura, we evaluated (1) the role of the intensity and frequency of chemical stimulation (crisis) on skin sensitivity (2) sensitization of second order trigeminal and spinal neurons (3) the effectiveness of font treatment reference of the crisis, propranolol (4) the involvement of the brainstem (locus coeruleus (LC) and periacqueductal grey matter (PAG)) in the sensitization of trigeminal and spinal neurons and (5) the involvement of LC changes in skin sensitivity induced by chemical stimulation of the dura. Our behavioral study reveals that topography (cephalic and / or extracephalic) and nature (static or dynamic) of allodynia induced by chemical stimulation of the dura is under the influence of two factors: intensity and frequency of stimulation, which may lead to its persistence. Our electrophysiological and behavioral studies confirm that the cephalic and extracephalic cutaneous allodynia reflects awareness of trigeminal and spinal neurons, respectively, which may become persistent. Propranolol permits to prevent changes in cutaneous allodynia, and trigeminal and spinal sensitization. We also observed the awareness of two brainstem structures: the PAG and LC which result in a persistent alteration of DNIC. However propranolol appears to prevent the alteration of these phenomena via inhibition of a single structure LC and not the PAG. Indeed, our microinjection of propranolol in the LC can prevent any changes induced by chemical stimulation of the dura. In conclusion these results suggest that the frequency and intensity of migraine attacks are two endogenous risk factors of migraine transformation. A marker of transformation is allodynia, which is the clinical expression of central sensitization of the dorsal horn neurons. This central sensitization is due to the direct arrival of information from the dura but also to an alteration of neuronal activity in LC. Based on these findings, one can suggest that patients with frequent and/or severe migraine attacks take as early as possible a migraine prophylactic treatment. This treatment should prevent the cumulative adverse functional consequences on the central nervous system of the activation of dural nociceptors.