Objectives and background: We aimed to explore the effect of greater occipital nerve (GON) infiltration on trigeminal transmission and its relation to clinical response. Infiltration of the GON with a local anesthetic and corticosteroids is effective in the treatment of both episodic (ECH) and chronic cluster headache (CCH). This effect is hypothesized to be due to delayed trigeminal transmission, resulting in a prolonged blink reflex with increased R2 latencies.
Methods: In this single-center, prospective cohort study, participants with either ECH or CCH were followed 12 weeks post-GON infiltration with daily e-diary monitoring and nociceptive blink reflex measurements at four timepoints: 30 min before infiltration; and 30 min, 1, and 4 weeks post-infiltration. The primary outcome was the R2 latency. Secondary outcomes were attack frequency and intensity. Data were collected between October 2020 and March 2023.
Results: A total of 33 participants were included in the primary analysis. No increased R2 latencies after GON infiltration were observed. When compared to baseline, daily attack frequency was significantly reduced during Week 1 (ECH: Δ -2.17, 95% confidence interval [CI] -3.43 to -0.64; CCH: Δ -1.36, 95% CI -1.93 to -0.71) and Week 4 (ECH: Δ -2.90, 95% CI -3.86 to -1.36; CCH: Δ -1.57, 95% CI -2.43 to -0.57), as was the attack intensity in Week 1 (ECH Δ -2.1, 95% CI -3.4 to -0.9; CCH: Δ -1.5, 95% CI -2.3 to -0.7) and Week 4 (ECH Δ -3.6, 95% CI -6.4 to -0.8; CCH: Δ -1.7, 95% CI -2.6 to -0.7) after GON infiltration compared to baseline. In all, 76% (25/33) of participants experienced a ≥30% reduction of their CH attacks and 27% (9/33) were attack free in Week 4. Unexpectedly, the R2 latency slightly decreased, but only in a solitary measurement ipsilateral to the infiltration side 4 weeks post-infiltration. No correlation between R2 latencies and clinical response were observed.
Conclusion: The observed neurophysiological alterations were minor and were not associated with any clinical outcome. Therefore, despite rigorous analysis of multiple neurophysiological parameters in a relatively large patient sample, we did not find any evidence that the clinical response of GON infiltration is caused by reduced-or modulated-transmission of the trigeminal nerve or the trigeminal cervical complex. Although effective, the mechanism of the GON infiltration thus remains enigmatic.
Objective: To quantify the prevalence of migraine and examine its association with sleep disorders, patterns, and symptoms in adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). We hypothesized that migraine would be associated with insomnia but not sleep apnea.
Background: Sparse research has examined migraine prevalence and sleep comorbidities in underrepresented racial and ethnic groups in the United States. Hispanic/Latino adults in the United States may be at risk for worse health outcomes due to disparities in health-care access and socioeconomic stressors.
Methods: We analyzed data collected during the baseline examination (March 2008-June 2011) from the HCHS/SOL, a community-based cohort study of self-identified Hispanic/Latino adults in the United States. The exposure was self-reported medical diagnosis of migraine, and primary outcomes were obstructive sleep apnea (apnea-hypopnea index ≥ 15 events/h from at-home sleep testing) and insomnia (≥ 9 on the Women's Health Initiative Insomnia Rating Scale). Exploratory outcomes included self-reported sleep duration, timing, sleeping pill use, and naps. We compared weighted differences in outcomes by migraine status, adjusting for age and sex in all reported models.
Results: Our analytical sample included HCHS/SOL participants who completed questionnaires on sleep and migraine (16,325). The mean age (standard deviation) was 41.1 (31.7) years, 52.2% identified as female, and 39.5% had a body mass index ≥ 30 kg/m2. Lifetime prevalence of migraine was 15.9% (95% confidence interval [CI]: 15.0, 16.8; 23.6% [95% CI: 22.2, 25.0] of females and 7.5% [95% CI:6.6, 8.5] of males). Those with migraine were more likely to be unemployed (50.8% vs. 36.2%) and to have a household yearly income of < $20,000 (50.9% vs. 45.5%). There was no association between migraine and obstructive sleep apnea (odds ratio [OR] 0.98 [95% CI: 0.76, 1.26]) or napping (OR 0.92 [95% CI: 0.81, 1.06]). Compared to individuals without migraine, those with migraine were more likely to have insomnia (OR = 1.87; 95% CI: 1.62, 2.15) and to use sleeping pills (OR = 2.16; 95% CI: 1.80, 2.60) in sex- and age-adjusted models. Individuals with migraine also had shorter mean sleep duration (7.88 ± 2.5 h vs. 8.00 ± 2.1 h, β = -0.20; 95% CI: -0.30, -0.09) and later bedtimes (11:28 p.m. ± 5.1 h vs. 11:17 p.m. ± 4.2 h, β = 16.85; 95% CI: 3.58, 30.13; weekdays) in sex- and age-adjusted models.
Conclusion: Self-reported medical diagnosis of migraine is common in Hispanic/Latino adults, especially females. Migraine is not associated with obstructive sleep apnea. Consistent with non-Hispanic/Latino populations, migraine is associated with insomnia in the HCHS/SOL.
Objectives/background: Nearly 12% of Americans experience migraine, with 75% of that group represented by women aged 15-55 years, notably including peak childbearing years. This presents a therapeutic dilemma for pregnant patients, given that most medications for migraine range from unknown teratogenicity in human pregnancies, at best, to known teratogenicity, severely limiting their utility. However, migraine causes significant disability and impairment in the lives of pregnant patients, necessitating treatment. We conducted a retrospective chart review and phone survey to evaluate the safety profile and effectiveness of bilateral occipital nerve blocks to treat migraine during pregnancy.
Methods: We conducted a retrospective review of charts of women aged 18-50 years who received bilateral occipital nerve blocks at the Stanford Headache Clinic between January 1, 2014 and December 31, 2020 during their pregnancies for the treatment of migraine and followed up with phone call surveys to address fetal outcomes as well as effectiveness of the nerve blocks.
Results: Thirty patients met inclusion criteria, and 21 responded to our survey. Of the 21 surveyed, none experienced significant pregnancy complications, negative fetal outcomes, or an increased rate of miscarriage. Participants receiving nerve blocks noted a reduction in pain on a visual analog scale from an average of 7 to 2 (p < 0.001) as well as from 9 days to 4 days of acute medication use per month (p = 0.002).
Conclusion: Based on this limited retrospective cohort study, serial occipital nerve blocks may offer a safe and potentially effective option for treatment of migraine during pregnancy. Occipital nerve blocks may improve the overall quality of life, decrease disability rates, and decrease the use of potentially teratogenic therapies in pregnant women. Future larger and prospective studies are needed to better assess the safety profile and effectiveness of occipital nerve blocks for pregnant patients with migraine.
Objective: We set out to examine detailed phenotypic data from our clinic for associations of vertigo in chronic migraine.
Background: Vertigo is a non-canonical, common symptom of migraine. Little is known about its associations with other symptoms within the migraine phenotype. There is significant methodological heterogeneity and therefore inadequate overall evidence about the potential differences in efficacy of any migraine treatments in patients with problematic vertigo associated with migraine, compared to those without vertigo. Enhancing understanding of migraine-related vertigo could help guide treatment and inform on mechanisms of vestibular migraine, a poorly understood diagnostic entity.
Methods: Chronic migraine extended phenotypes of patients seen within the adult headache service at King's College Hospital Tertiary Headache Service between January 2014 and December 2021 (n = 589) were extracted from the first documented clinic consultation letter retrospectively. For those with information about vertigo (n = 562), potential associations of interest for the presence of vertigo (gender, allodynia, aura, photophobia, phonophobia and osmophobia, baseline headache frequency, number of premonitory symptoms, presence of cranial autonomic symptoms, and age) were analyzed using a regression model (IBM SPSS v 29). Missing data were excluded (final n = 435).
Results: The total sample size for analysis in the regression model was n = 435, after excluding missing data (n = 126) and outliers (n = 1). Patients were 16-92 years old (median, 47; interquartile range, 37-55), and the majority (83.4%) were female. Vertigo associated with migraine was present in 275 of 562 (49%) patients. Within the regression model, the presence of aura (odds ratio, 2.13; 95% confidence interval, 1.4-3.23, P < 0.001) and allodynia (odds ratio, 2.74; 95% confidence interval, 1.76-4.26, P < 0.001) were positively associated with vertigo.
Conclusions: Vertigo in chronic migraine is common and may be associated with a more enriched phenotype independent of baseline headache frequency. Future treatment strategies should be evaluated for their effects on this often under-recognized yet disabling symptom.
Objective: This study aimed to evaluate the choroid plexus volume in patients with spontaneous intracranial hypotension (SIH), including the lateral, third, and fourth ventricles, and explore its potential relationship with clinical characteristics.
Background: SIH is caused by cerebrospinal fluid (CSF) leaks. The choroid plexus is predominantly responsible for CSF production and has been implicated in altered CSF dynamics in various neurological conditions.
Methods: This retrospective case control study included 25 patients with SIH who were diagnosed between 2022 and 2024 from a single tertiary center. In addition, 25 age- and sex-matched healthy controls were included. Choroid plexus volumes were manually segmented from 3D contrast-enhanced magnetization-prepared rapid acquisition gradient echo MRI sequences using 3D Slicer. The total intracranial volume was also calculated. Clinical data, including the Bern score and Headache Impact Test-6 score, were collected from patients with SIH. Group differences in choroid plexus volumes were assessed using a generalized linear mixed model for the lateral ventricles and multivariable linear regression for the third and fourth ventricles, adjusting for age, sex, body mass index, and total intracranial volume. Associations with clinical variables were evaluated using univariable linear regression.
Results: After adjusting for covariates, the choroid plexus volume in the lateral ventricles was significantly higher in patients with SIH compared to that in healthy controls (unstandardized regression coefficient = 201.81 mm3, p = 0.016). However, no significant differences were observed in the choroid plexus volumes of the third (p = 0.617) and fourth ventricles (p = 0.314). Additionally, choroid plexus volume was not associated with disease duration (p = 0.292), Bern score (p = 0.580), and Headache Impact Test-6 score (p = 0.539) in patients with SIH.
Conclusion: The lateral ventricular choroid plexus is enlarged in patients with SIH, which may represent a compensatory response to CSF hypovolemia.
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