Sammanfattning Syfte Syftet med denna systematiska litteraturstudie är att sammanställa aktuella forskningsresultat om vilken fysisk träning som behandling kan ge eventuell positiv effekt för personer med diagnosen migrän med avseende på frekvensen, intensiteten och durationen vid migrän. Frågeställningar - Kan träning minska frekvensen, intensiteten och durationen vid migrän? - Vilken typ av träning kan minska konsekvenserna vid migrän? Metod En systematisk litteraturstudie där litteratursökningen utfördes i databaserna PubMed, PEDro och Cochrane. Totalt inkluderades fem studier som analyserades närmare. Studierna kvalitetsgranskades enligt PEDro-scale. Evidensgradering utfördes genom Statens Beredning för Medicinsk Utvärderings (SBU) graderingsmetod. Resultat Det finns ett starkt vetenskapligt stöd för att frekvensen vid migrän minskar, ett måttligt starkt vetenskapligt stöd för att intensiteten vid migrän minskar och ett begränsat vetenskapligt stöd för att durationen minskar med träning som behandling vid migrän. En indikation finns att läkemedelskonsumtionen minskar, dock utgör studierna ett otillräckligt vetenskapligt underlag. Det finns ett otillräcklig vetenskapligt underlag gällande längden på träningsperioden, längden per tillfälle och antalet träningstillfällen. Det finns stark evidens för att träningen ska utföras på en submaximal nivå. En indikation finns att konditionsträning kan fungera som behandling vid migrän, dock är det vetenskapliga underlaget otillräckligt. Slutsats Träning som förebyggande behandling kan minska konsekvenserna vid migrän. Träningens effekter kan minska frekvensen, intensitet och durationen vid migrän. Ingen slutsats kan dras gällande tidsåtgången för träningen. Intensiteten i träningen bör vara submaximal.  Konditionsträning kan fungera som behandling vid migrän. Fler studier i området krävs för att kunna ge tydligare riktlinjer. Studier med hög kvalitet efterlyses. / Abstract Aim The purpose of this systematic literature review is to compile current research on the physical exercise as treatment is possible to have a positive effect for people diagnosed with migraine with respect to the frequency, intensity and duration of migraine. Questions- Can exercise reduce the frequency, intensity and duration of migraine?- What type of exercise can reduce the impact of migraine?  Method A systematic study of the literature search was performed in the database PubMed, PEDro and Cochrane. Five studies were included and analyzed. The quality of the studies was examined according to the Pedro-scale. The evidence grade was performed by using Statens Beredning för Medicinsk Utvärdering (SBU) grading method.  Results When exercise is used as a treatment for migraine, there is strong scientific evidence that the frequency of migraine decreases, moderately strong scientific evidence that the intensity of migraine decreases and limited scientific evidence that the duration decreases. The results indicated that the drug consumption is decreased when exercise is used on regular basis, however the studies show insufficient scientific evidence. There is insufficient scientific data regarding the length of the training period, the length per session and the number of training sessions. There is strong evidence that the exercise should be performed at a sub-maximal level. Cardiovascular exercise might be an effective and suitable treatment for migraine, but the scientific evidence is insufficient. Conclusions Exercise as a preventive treatment can reduce the impact of migraine. The effects of exercise can reduce the frequency, intensity and duration of migraine. No conclusion can be drawn regarding the duration of the training. The intensity of the exercise should be on a sub-maximal level, and aerobic exercise can be used. However, more studies in this important area are required to provide appropriate guidelines. Studies with high quality is necessary.

Migraine headache is one of the most common neurological disorders. While the mechanisms contributing to migraine pathophysiology have yet to be fully elucidated, the disproportionate number of post-pubescent, pre-menopausal women affected suggests a central role for female hormones, such as estrogen. The mechanism(s), however, by which estrogen contributes to migraine have yet to be deciphered. Cortical spreading depression (CSD) is associated with "Classic Migraine", now referred to as migraine with aura. Here we use a well-established animal model for migraine with aura to test the putative role of estrogen in the development of CSDs in awake and freely moving female rats. Beta estradiol administration in ovariectomized female rats resulted in a significant increase in CSD episodes over a 12-hour recording period. Additionally, beta estradiol administration in these rats promoted migraine-associated behavior, significantly reducing exploratory behavior (i.e., number of vertical rearing episodes) when compared to vehicle-treated controls. Critically, the increase in CSD episodes was completely abolished with pre-administration of ICI 182,780 a pure alpha and beta estrogen receptor antagonist. ICI 182,780administration also blocked beta estradiol-induced migraine-associated behaviors, restoring vertical rearing episodes to baseline levels. These data illustrate that an increase in estrogen levels in an animal that no longer produces estrogen (postmenopausal characteristic) can promote the development of CSDs. These data suggest that an estrogen receptor-mediated mechanism may drive episodes of migraine with aura and highlight the need for further investigation into estrogen's role in migraine.

Background Migraine is a comprehensive endemic disease who is affecting both women and men, but with higher prevalence among women because of hormonal factors. Risk factors for the disease are female gender, hereditariness, depression and socio-economic factors. Migraine can be triggered by factors like stress, menstruation, irregular routines for sleep and unbalanced meals and diet. Migraine is a condition that causes a big suffering for the affected individuals. Aim The aim of this study was to describe individuals' experiences of how migraine is affecting the daily life, out of the aspects like working life, family life and social life. Method A literature overview was maintained, and eight qualitative studies and two quantitative studies between the years 2003- 2014 were analyzed. Results The analysis of the articles lead to one main theme; "Guilt, compensating and restrictions" and seven subthemes "Not being able to perform their best", "Met with incomprehension", "Not being able to take care of home and children", "Not enough", "Avoiding activities", "Always be prepared" and "Living with restrictions". Conclusion Migraine is affecting the daily life among these individuals in a great extent. The disease makes it hard to perform well at work. The individuals where met with incomprehension which made them feel questioned. It was though for the individuals to take care of their home and family. The restricted life that they had and not being able to participate in activities caused isolation. All of this caused feelings of guilt.

Diss. (sammanfattning) Umeå : Univ., 2006. / Härtill 4 uppsatser.

Thesis (Ph.D.)--Ohio University, August, 2004. / Includes bibliographical references (leaves 105-113)

Includes bibliographical references and index.

Background Individually both migraine and post-traumatic stress disorder (PTSD) prevalence estimates are higher among women. However, there is limited data on the association of migraine and PTSD in women during pregnancy. Methods We examined the association between migraine and PTSD among women attending prenatal clinics in Peru. Migraine was characterized using the International Classification of Headache Disorders (ICHD)-III beta criteria. PTSD was assessed using the PTSD Checklist-Civilian Version (PCL-C). Multivariable logistic regression analyses were performed to estimate odds ratios (OR) and 95% confidence intervals (CI) after adjusting for confounders. Results Of the 2922 pregnant women included, 33.5% fulfilled criteria for any migraine (migraine 12.5%; probable migraine 21.0%) and 37.4% fulfilled PTSD criteria. Even when controlling for depression, women with any migraine had almost a 2-fold increased odds of PTSD (OR: 1.97; 95% CI: 1.64–2.37) as compared to women without migraine. Specifically, women with migraine alone (i.e. excluding probable migraine) had a 2.85-fold increased odds of PTSD (95% CI: 2.18–3.74), and women with probable migraine alone had a 1.61-fold increased odds of PTSD (95% CI: 1.30–1.99) as compared to those without migraine, even after controlling for depression. In those women with both migraine and comorbid depression, the odds of PTSD in all migraine categories were even further increased as compared to those women without migraine. Conclusion In a cohort of pregnant women, irrespective of the presence or absence of depression, the odds of PTSD is increased in those with migraine. Our findings suggest the importance of screening for PTSD, specifically in pregnant women with migraine.

Objectives: 1) To describe the state of the evidence for interventions in pediatric migraine, 2) to survey experts regarding non-inferiority margins in migraine research and 3) to design a clinical trial in this area of research. Methods: A systematic review was carried out to identify randomized, placebo-controlled trials of pharmaceutical and nutraceutical interventions used to prevent migraine in children and adolescents, using Cochrane methods. Secondly, neurologists with expertise in Headache Medicine were invited to participate in a survey regarding their opinions on non-inferiority margins for outcomes used in clinical trials of migraine interventions. Thirdly, a protocol was written for a three-arm, parallel-group, randomized trial comparing the efficacy and safety of topiramate, levetiracetam and placebo for the prophylaxis of pediatric migraine. Results: The systematic review identified 19 articles of 12 interventions for pediatric migraine. The quality of the evidence was poor and few conclusions could be made. Ninety-nine eligible respondents completed the survey and non-inferiority margins for six outcomes were determined. A randomized controlled trial protocol was developed to determine if topiramate and levetiracetam are superior to placebo, and if levetiracetam is non-inferior to topiramate for the prevention of migraines in children and adolescents. Conclusions: It is hoped that the results of this thesis can be applied to further the evidence in this area of clinical research.

The CGRP monoclonal antibodies are the first class of medication developed specifically for migraine prevention, in contrast to previous preventative medications, that were in the anti-hypertensive, anti-epileptic and anti-depressant class. There are two notable divisions within the CGRP inhibitor class: the CGRP monoclonal antibodies (CGRP mAbs), and the small molecule CGRP antagonists (gepants). This thesis conducts a retrospective analysis of notable clinical trials such as the ACHIEVE I, ACHIEVE II, LIBERTY, ARISE, STRIVE, PREEMPT, and COMPEL studies to determine the efficacy of CGRP inhibitors. In ACHIEVE I, 38.6% of participants in the 50 mg ubrogepant group experienced pain freedom 2 hours post dose (p=0.002) and in ACHIEVE II trial in the 50 mg ubrogepant group, 21.8% reported pain freedom 2 hours. In participants that received Rimegepant at a 75mg dose, 21%of participants reported more freedom from pain at 2 hours than placebo (p<0.0001).^40 In another study, participants received placebo, 50 mg and 100 mg of sumatriptan.^43 Results of the study showed that more than half of participants, 57%, in the 100 mg Sumatriptan group and exactly half of participants in the 50 mg group had pain relief at 2 hours post-dose.^43 In the LIBERTY trial, at 12 weeks, 30% of individuals that received erenumab reported a fifty percent or more reduction in the monthly number of migraine days than individuals in the placebo group (p=0.002).^45 In the STRIVE trial, the average number of migraine days experienced by the participant at baseline was 8.3, and was assessed by the 4th month through the 6th month. This baseline decreased to 5.1 days (a 3.2 difference) in the participants that received an injection of 70 mg of erenumab (p<0.001).^46 The participants that received an injection of 140 mg erenumab, decreased from the baseline to 4.6 days of migraine (a 3.7 difference) (p<0.001) . 46 Participants that received placebo reported the least change from baseline, only a 1.8 day change (p<0.001).46 In the ARISE Trial patients receiving erenumab experienced a change of 2.9 monthly migraine days, a 1.1 increase from the reported change of 1.8 days reported by study participants for the monthly migraine days in the placebo group (p<0.001).^47 The PREEMPT1 trial did not meet statistical significance for their primary endpoint or study measure, which was to assess for a mean change in monthly mean headache episode frequency between baseline and week 24 of the trial (p=0.344)^48. Participants in the PREEMPT2 trial experienced a reduction by 9 days when compared to placebo for the primary end point, frequency of headache days per 28 days relative to baseline (p<0.001)^49. In the COMPEL study, participants experienced -10.7 day reduction in headache days by 108 weeks (p<0.0001).^50 There are several advantages to CGRP mAbs. Patients are more likely to adhere to CGRP mAbs medication and tolerate this medication than other medication options^17, CGRP mAbs do not give rise to toxicity in the liver because these medications do not interact with the liver^17, and CGRP mAbs have a long duration in the human body as they have a half-life of 20 to 30 days which provides patients with the opportunity to not take the medication as frequently.^51 Another reason why CGRP mAbs are advantageous compared to traditional treatment options is that they have a strong affinity and specificity for the CGRP receptor or CGRP molecule. This high specificity prevents the medication from causing undesirable effects on other receptors^51.

Objective. - To compare patient recall of migraine headache frequency and severity over 4 weeks prior to a return visit as reported in an interval questionnaire vs a daily diary. Background. - Many therapeutic decisions in the management of migraine patients are based on patient recall of response to treatment. As consistent completion of a daily headache diary is problematic, we have assessed the reliability of patient recall in a 1-time questionnaire. Methods. - Headache frequency and average severity (0 to 3-point scale) were reported in an interval questionnaire by 209 patients who had also maintained a daily diary over the same 4-week period. Results. - Headache frequency over the previous 4 weeks as reported in interval questionnaires (14.7) was not different from that documented in diaries (15.1), P =.056. However, reported average headache severity on a 0 to 3 scale as reported in the questionnaire (1.84) was worse than that documented in the diaries (1.63), P <.001. Conclusions. - In the management of individual patients, the daily diary is still preferable when available. Aggregate assessment of headache frequency in groups of patients based on recall of the prior 4 weeks is equally as reliable as a diary. Headache severity reported in questionnaires tends to be greater than that documented in daily diaries and may be less reliable.