We performed greater occipital nerve blocks on 24 migraineurs with unilateral migraine and trigeminal nerve distribution allodynia. Using a visual analog scale for migraine pain, brush allodynia in the trigeminal nerve distribution and photophobia were reduced 64%, 75%, and 67%, respectively, after 5 minutes. Allodynia improved faster than headache. The results of this study suggest that greater occipital nerve blocks initiate an inhibitory process that shuts down several symptom generators.

Migraine headache is a painful and often serious problem in the United States. There are many prophylactic pharmacological and nonpharmacological treatments available for migraine headaches. However, choosing between them can be difficult for individuals and treatment providers alike. The primary literature regarding the effectiveness of pharmacological and nonpharmacological treatments is quite dense. More than 191 primary studies were identified as providing information about the effectiveness of one or more treatments for migraine headaches. Of these, 82 articles were retained for meta-analyses on six prophylactic treatments for migraine: propranolol, flunarizine, divalproex sodium, thermal biofeedback, relaxation treatments, and combined treatments. These results suggest that all of the treatments examined have very similar treatment effect sizes. Effect sizes for the reduction of migraine were found to be between .60 and .75 for all treatments. Results suggest that selection of treatment for migraine must be based on more than treatment effectiveness rates alone.

Cerebrovascular accidents (CVAs) are a leading cause of morbidity and mortality in the United States. Metabolic derangements such as hypoglycemia, infections, brain masses or lesions, neurodegenerative disorders, neuropathies, myelopathies, seizures, syncope, types of migraines, and many other disorders may mimic CVA. Our case presents a 38-year-old female who was evaluated in the emergency department with a three- hour history of headache, lethargy, left- sided upper extremity weakness, facial droop, and dysarthria. A CVA workup was initiated and she immediately underwent a computed tomography (CT) scan of the head which revealed no intracranial hemorrhage. She was unable to provide a thorough medical history due to lethargy, however she was able to answer yes/no questions to screen for tissue plasminogen activator (tPA) qualification. She qualified based on her screening results and was administered tPA for her presumed ischemic CVA. She was then monitored in the intensive care unit for twenty-four hours. Due to reoccurrence of headache and left-sided weakness, as well as recent administration of tPA increasing risk of hemorrhage, she underwent two subsequent negative non- contrast head CT scans to rule out bleeding during that time. On hospital day two, magnetic resonance imaging (MRI) of the head, neck, and spine were performed which were also negative for infarct or hemorrhage. A more detailed history from our patient revealed previous migraine headaches, but her left sided weakness and dysarthria were new symptoms. With this information, it was suspected that she was suffering from a hemiplegic migraine, a rare mimic of CVA. Prochlorperazine, diphenhydramine, valproic acid, and corticosteroids were administered for migraine treatment, which aborted her symptoms entirely. Topiramate was then started for migraine prophylaxis. Daily low-dose aspirin was also initiated due to inability to fully rule out CVA/transient ischemic attack (TIA). An outpatient neurology follow up was scheduled on discharge. In clinical practice, hemiplegic migraines and CVA/TIA may be difficult to differentiate as symptoms often overlap. A detailed history and physical exam with careful attention to associated symptoms and timing of symptom onset is essential to formulating a correct diagnosis. This must be done quickly, as tPA is a high-risk medication with a narrow time window for administration. In conclusion, not all disease processes have an available “gold standard” diagnostic test to differentiate similar diagnoses. MRI of the brain is usually performed to differentiate ischemic CVA from TIA; however, imaging is not useful to differentiate hemiplegic migraine from TIA. Therefore, performing a thorough history, physical exam, and chart review is paramount to provide patients with the correct treatment as well as prevent adverse outcomes. It is the responsibility of the clinician to make difficult decisions weighing the risks and benefits of providing various treatments or interventions, and to know the complications of those treatments. Disease processes mimicking CVA must be considered in all patients, as treating an incorrect diagnosis can have devastating effects.

BACKGROUND: Identifying factors related to migraine onset is essential to effective treatment because it would allow patients to take prophylactic measures to reduce the likelihood of migraine occurrence. The experience of intense emotions is a potential factor affecting migraine onset. This study aimed to explore the relationship between day-to-day experience of emotions (specifically the intensity of sadness, happiness, anxiety/stress, and interpersonal stress) and migraine onset. METHODS: Thirty adult women with episodic migraine were recruited to engage in a 12-week monitoring period that involved wearing a Fitbit and answering daily questionnaires by mobile app. The daily questionnaires asked about headache occurrence and triggers, emotional intensity, and sleep. A series of linear regressions were carried out to understand the overall relationship between emotional intensity and the onset of migraine over the 12-week period. In addition, mixed effects models were used to explore the temporal relationship between participants’ reported emotional intensity on a given day and migraine occurrence the next day. RESULTS: The linear regressions for migraine occurrence and headache occurrence as a function of emotional intensity were not significant. However, mixed effects models showed that emotion intensity and migraine onset were significantly associated for happiness (estimate = -0.081; p = .027), anxiety/stress (estimate = 0.060; p = .040), and interpersonal stress (estimate = 0.12; p = .0017) but not sadness (estimate = 0.025; p = .46). CONCLUSIONS: Findings suggest that high levels of anxiety/stress and interpersonal stress predict onset of migraine the next day. Similarly, low levels of happiness predict onset of migraine the next day. However, these relationships are no longer significant when emotional intensity is averaged over the 12-week monitoring period. Taken together, these findings support the need for longitudinal research evaluating the temporal relationship between emotion and migraine occurrence, particularly because important relationships may be lost with cross-sectional studies. Furthermore, these findings point to the potential role of strong negative emotions and the absence of positive emotions in producing migraine.

Migräne ist die häufigste neurologische Erkrankung und kann mit einem hohen Grad der Beeinträchtigung einhergehen. Neben nichtmedikamentösen Ansätzen zur Reduktion der Migränefrequenz stehen medikamentöse Migräneprophylaxen zur Verfügung. Zur Indikation und Anwendung liegen evidenzbasierte Leitlinien der Deutschen Migräne- und Kopfschmerzgesellschaft (DMKG) und Deutschen Gesellschaft für Neurologie (DGN), Österreichischen Kopfschmerzgesellschaft (ÖKSG) sowie Schweizer Kopfwehgesellschaft (SKG) vor. Für therapierelevante Fragen wie z. B. der notwendigen und sinnvollen Dauer einer medikamentösen Migräneprophylaxe können aus bisherigen Studiendaten keine Rückschlüsse gezogen werden. Ziel dieser Übersicht ist die Formulierung von Empfehlungen zur Therapiedauer bei wirksamer medikamentöser Migräneprophylaxe, die die aktuelle Datenlage und – bei fehlenden Daten – die Expertenmeinungen berücksichtigen. / Migraine is the most common neurological disorder and can be associated with a high degree of disability. In addition to non-pharmacological approaches to reduce migraine frequency, pharmacological migraine preventatives are available. Evidencebased guidelines from the German Migraine and Headache Society (DMKG), and German Society for Neurology (DGN), Austrian Headache Society (ÖKSG), and Swiss Headache Society (SKG) are available for indication and application. For therapyrelevant questions such as the duration of a pharmacological migraine prevention, no conclusions can be drawn from currently available study data. The aim of this review is to present a therapy consensus statement that integrates the current data situation and, where data are lacking, expert opinions. The resulting current recommendations on the duration of therapy for pharmacological migraine prophylaxis are shown here.

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La littérature scientifique décrit en détail les différentes formes de migraines et céphalées, ainsi que leur prévalence. Des données statistiques sont également disponibles concernant l'absentéisme, le présentéisme et le fardeau financier associés. Cependant, contrairement à d'autres problématiques de santé chronique et troubles de santé mentale, peu d'études se sont intéressées à la dynamique entre migraine chronique et travail. Ce mémoire vise à documenter cette dynamique. Pour ce faire, huit personnes ont participé à des entrevues individuelles semi-dirigées. Les entrevues ont été codifiées selon la méthode de « *thématisation en continu* » de Paillé & Mucchielli, (2016). Le cadre conceptuel de ce mémoire s'inspire de l'ethos du travail de Mercure & Vultur (2010), du modèle d'analyse des parcours de vie professionnels de Fournier et al. (2016) et du modèle « job demand/ressource » de Bakker & Demerouti (2007). Les participants ont partagé des expériences de vie qui ont permis de mieux comprendre les éléments influençant le choix professionnel, l'intégration au travail et le maintien en emploi dans un contexte de migraine chronique. Pour certains, la migraine chronique a eu une incidence directe sur leur choix professionnel en raison des obstacles rencontrés durant leurs études. Les participants ont majoritairement rapporté que l'intégration au travail avait été une période charnière marquée par une exacerbation des symptômes et l'accumulation d'obstacles (absentéisme, préjugés, manque de soutien, etc.). Ils ont progressivement pris conscience de la dynamique travail-maladie, et la santé est devenue centrale dans leur manière de vivre le travail. Ainsi, ils ont cherché à se maintenir en emploi. Pour certains, l'emploi a changé, tandis que pour d'autres, l'emploi s'est maintenu dans un nouvel environnement. De plus, l'analyse montre que les conditions organisationnelles et les risques psychosociaux du travail (charge de travail, horaires, flexibilité, soutien, etc.) ont une incidence directe sur la condition de santé, pouvant diminuer ou exacerber les symptômes. Ce mémoire permet une meilleure compréhension de la dynamique de la migraine chronique avec la vie professionnelle. Il apporte également de nouvelles connaissances dans le domaine des sciences de l'orientation qui s'est très peu intéressé à cette population de travailleurs. Les résultats permettent aussi de rendre visibles des parcours professionnels de personnes vivant avec une maladie chronique dite « invisible » et de sensibiliser les employeurs aux réalités professionnelles vécues par les personnes ayant une condition de migraine chronique.

To aid in understanding headache etiology and symptomatology, psychological and physiological variables were examined in patients with migraine and combination headaches (combined migraine and muscle-contraction headaches). One hundred patients being evaluated for treatment of their headaches at The New England Center for Headache participated in this study. They were assigned to the migraine or combination group, based on diagnoses made by three headache specialists—a psychologist, a psychiatrist, and a nuerologist. Personality data from the MMPI and frontalis electromyographic readings reflecting muscle tensions across three stimulus conditions were compared between the two groups. Subjects were also asked to rate the perceived level of stress elicited by the three conditions.

La céphalée migraineuse est une pathologie invalidante qui représente un véritable problème de santé publique. Cette maladie chronique se déroule en crises récurrentes de 4 à 72 heures. Les douleurs observées résultent de la mise en jeu du système trigémino-vasculaire formé par les vaisseaux sanguins cérébraux et méningés et les fibres nerveuses nociceptives trigéminales. Ces fibres nociceptives expriment une large gamme de protéines (canaux ioniques) spécialisées dans la détection et la propagation du message douloureux. Parmi eux, le canal ionique Nav1.9 revêt un intérêt particulier en raison de son expression restreinte aux neurones nociceptifs et de son rôle prépondérant dans l'activité des nocicepteurs. Les résultats obtenus dans notre laboratoire montrent que le canal Nav1.9 est un acteur majeur de la céphalée migraineuse et doit être considéré comme une cible thérapeutique prometteuse dans le traitement de la migraine. Nous cherchons maintenant à comprendre quel est le rôle du système immunitaire, et en particulier des mastocytes, dans la céphalée migraineuse. Les mastocytes sont localisés à proximité des vaisseaux sanguins méningés, en étroite apposition avec les fibres nociceptives. Les mastocytes sont connus pour libérer un grand nombre de médiateurs de l'inflammation par un processus de dégranulation. Nous pensons que ces facteurs sécrétés agissent sur le canal Nav1.9 et contribuent à amplifier l’inflammation neurogène et la céphalée. Nos travaux visent donc à évaluer le poids de la dégranulation mastocytaire dans la phase de céphalée migraineuse, à en comprendre les mécanismes intimes et à développer de nouveaux médicaments sur la base de ces mécanismes. / Résumé vulgarisé en anglaisMigraine is a common neurological disorder that affects a large portion of the population. This chronic disease occurs in attacks or episodes that can cause significant pain (4 to 72 hours) accompanied by light (photophobia) and sound (phonophobia) sensitivity and cutaneous hypersensitivity. Current treatments have many side effects and remain ineffective in chronic conditions.Migraine pain results from the activation of nociceptive pathways (fibers of pain) at the level of meningeal vessels. These nociceptive fibers express a wide range of proteins (ion channels) specialized in the detection and spread of the pain message. Among them, the ion channel Nav1.9 is particular interest because of its restricted expression to nociceptive neurons and its preponderant role in the activity of nociceptors. We developed a model of migraine headache in mice that has all migraine symptoms. These symptoms disappear when the gene encoding the Nav1.9 channel has been invalidated. We have shown that activation of the Nav1.9 channel is responsible for pain during a migraine attack and that it is involved in sterile neurogenic inflammation of the meninges.The results obtained show that the Nav1.9 channel is a critical determinant of migraine attack and emerges as a promising target for migraine therapeutics.