migraine with aura

10 March 2022

Large International Migraine Genetic Study

Last month a report was published on a large international genetic study that is giving us more clues in the world of migraine genetics.

The study, published in Nature Genetics, included 102,084 migraine cases and 771,257 controls. 123 “loci” were identified – that is, the locations on a chromosome, that seem to be connected with either migraine or migraine with aura. Here are a few of the findings:

123 loci is a big increase from what we knew before. 86 were previously unidentified.
The study did specifically split up two main migraine types – with and without aura. And there does seem to be a difference. Some genetics risks seem to be specific to one or the other. That not only means a biological difference, but possible future specific treatments.
Researchers found new evidence for treatments we already have – CGRP related drugs. In their words, “Our findings also include new risk loci containing target genes of recent migraine drugs acting on the CGRP pathway and the serotonin 5-HT1F receptor.”
The new study confirms again that migraine is “polygenic”. That is, it probably arises from multiple causes.
The loci especially related to the central nervous system (CNS) and the vascular system. That provides further confirmation that migraine is a neurovascular disease – that is, related both to the neurological system and blood vessels.
Although not as strong as the CNS and vascular connections, the study also found some connection to the digestive system and ovary tissue, suggesting a possible connection with these systems as well.

As mentioned above, this type of research not only helps us better understand migraine, it may also lead to genetic testing, better treatments, and even migraine-type specific treatments. But as the researchers note, although our study of genetics has come a long way, it still has a long way to go.

You can read the technical details and discussion from the researchers here: Genome-wide analysis of 102,084 migraine cases identifies 123 risk loci and subtype-specific risk alleles

For a good summary of the study, check out ScienceDaily: Largest genetic study of migraine to date reveals new genetic risk factors

7 July 2021

Migraine with Aura and Blood Clots

James Discoveries & Stats 0

A study published earlier this year in the journal Neurology may provide a clue about migraine’s link with cardiovascular conditions. The focus of the study? Blood clots.

The system that clots your blood is truly amazing. The technical term (and your word of the day) is hemostasis. Without it, even a small cut or a slightly damaged blood vessel within the body could be deadly. And yet, using an amazing series of communications and substances in the body, the blood stops flowing.

Of course, there are various diseases and conditions that can lead to problems. For some people, a cut is very serious, because there is a problem with the hemostasis system. For others, blood may clot when it’s not supposed to, causing other serious problems (thrombosis).

The recent study investigated coagulation proteins/clotting factors to see if there was any relationship with migraine with aura, or migraine without aura.

There is evidence that migraine in general, including migraine without aura, may be linked to heart conditions and stroke. But the link seems to be stronger with migraine with aura.

In this study, certain blood clotting factors (not all) were related specifically to migraine with aura. In case you’re interested, the von Willebrand factor, antihaemophilic factor A, and phosphorylated fibrinopeptide A, were all elevated in the migraine with aura patients, and fibrinogen was lower.

This is a complex system, so there is a lot of work to do to see how these blood clotting mechanisms relate to migraine. But this could be a big step toward understanding why migraine patients are at higher risk of heart disease, and it may also help us understand more about the mechanisms and causes of migraine itself.

To read another brief article on the study, check Potential causality between blood clot factors and migraine with aura at ScienceDaily.

11 October 2018

Diagnosing Migraine with Aura – New Criteria

James Information 0

Following up on the report about the new International Classification of Headache Disorders 3rd edition (ICHD-3), one of the most interesting changes, though a little technical, was the change in the diagnostic criteria for migraine with aura. This is to say, new more precise ways of diagnosing migraine with aura (MA).

There are many types of migraine, of course, and also many types of migraine with aura. When the beta edition of ICHD-3 came out several years ago, there was concern that MA could be confused with transient ischaemic attacks, or mini-strokes. This is one reason why more specific details were added to the definition.

Migraine aura So let’s take a quick look.

First, in order to actually be diagnosed with MA, you need to have more than one attack. That hasn’t changed. Also, it’s still possible that you could fit the criteria below, but you better fit a different diagnosis.

Next, you obviously need to experience an “aura”. In migraine, aura is something temporary, or “reversible”. Possible aura types include:

visual (such as seeing flashing lights or patterns)
sensory (often a “tingling” sensation)
speech and/or language (such as slurred speech)
motor (weakness)
brainstem (various specific auras, including vertigo or impaired hearing)
retinal (for example, vision loss in one eye)

We won’t get into the details of all of these. Some of these will help doctors diagnose what type of MA you have – remember, there are several sub-types. All you need is one of these symptoms to receive the MA diagnosis.

It’s interesting that these symptoms usually come in a predictable order, as the migraine chain-reaction spreads.

Finally, to be diagnosed with MA you must have at least three of the following six characteristics:

At least one aura symptom spreads gradually over 5 minutes or more.
Two or more aura symptoms occur in succession (has this ever happened to you? It’s probably more common than you think. This was added for clarification since the beta version.)
Each individual aura symptom lasts 5-60 minutes (so, yes, auras could last several hours if there are several auras. Note that motor symptoms are an exception – they could last for 2-3 days.)
At least one aura symptom is unilateral – on only one side.
At least one aura symptom is positive (for example, seeing flashing lights is positive, partial blindness is negative.)
The aura is accompanied, or followed within 60 minutes, by headache (presumably the aura ends, and then within 60 minutes there’s a headache. Or they overlap.

Note that these are aura symptoms, not prodrome symptoms. The difference is that the prodrome may start hours or even a day or two before the attack. It’s often less defined, but may include feeling tired or “heavy”, or having neck stiffness, or having unusual trouble concentrating.

Many of the above symptoms are shared with transient ischaemic attack (TIA), but it’s hoped that the specific details will help rule out TIA. The key symptom of TIA is one-sided weakness or numbness, although other symptoms such as vertigo or vision loss are not uncommon. Learn more about transient ischaemic attack here.

Of course, in either case, it’s best to see a neurologist who can confirm a diagnosis for you, and help you avoid even more serious problems down the road.

For details about various types of migraine with aura, click through the list here.

30 March 2018

Migraine and Headache and Pregnancy Q&A

James Information, Treatments 0

We have talked about headaches and migraine and pregnancy frequently at Headache and Migraine News. For example, don’t miss The Myth-Busting Guide to Migraines and Pregnancy for a good overview. We’ve also looked at some fascinating statistics about migraine during and after pregnancy.

We’ve also talked about the hot topic – How Dangerous are Migraine Drugs during Pregnancy?

For more information, just do a search here.

It’s always good to get another perspective, and NeurologyAdvisor recently published a Q&A on the topic with Dr. Matthew Robbins, associate professor of neurology at Albert Einstein College of Medicine, and director of inpatient services at Montefiore Headache Center New York.

I’ll let you read the article yourself, but I especially appreciated Dr. Robbins simple but helpful advice near the end.

I think some of the commonsense strategies of avoiding triggers is critical. Pregnancy is a time when usual routines can be disrupted, so the normal lifestyle strategies to help migraine should be especially emphasized during pregnancy. These include staying well hydrated (especially in early parts of pregnancy if someone has morning sickness), and getting regular sleep and maintaining low-grade or normal-level exercise. Nonpharmacologic treatments that are strongly evidence based for migraine, including biofeedback and relaxation training, certainly are good treatment strategies as well as preventive measures.

Your schedule is naturally disrupted during pregnancy. So – this is a great time to stop and evaluate your habits. And it’s important to develop healthy, regular habits that will help you avoid headache attacks.

Read the full article here: Managing Headache in Pregnancy: Q&A With Matthew Robbins, MD

5 March 2018

Migraine Increases Your Risk for Heart Disease – but what types?

James Discoveries & Stats 1

A recent study in the British Medical Journal aimed to find out which types of cardiovascular disease were more likely in migraine patients.

Migraine and Heart Disease It’s actually well known that migraine is associated with heart disease. Most often, the types mentioned are stroke and heart attack. But this study of tens of thousands of migraine patients gives us more insights into where the risk really is.

So your risk of these heart conditions may be increased if you have migraine:

Ischemic Stroke: The most common type of stroke. Yes, migraine tends to increase your risk.
Myocardial Infarction: More commonly known as heart attack. Yes, migraine seems to increase your risk.
Venous Thromboembolism (VTE): Also very common, third in line (in the vascular category) after stroke and heart attack. It is a blood clot that starts in a vein. Yes, migraine seems to increase your risk.
Atrial Fibrillation: The most common abnormal heart rhythm. Quite common in people over 65. Yes, migraine may increase your risk.
~~Heart Failure~~: Also very common, but migraine does not seem to increase your risk.
~~Peripheral Artery Disease (PAD)~~: A narrowing of the peripheral arteries to the legs, or possibly stomach, arms, or head. No increased risk with migraine.

The risk tended to be higher in women, and also in those who experienced aura with their migraine attacks.

It bears repeating that this is not a drastically increased risk. You’re not by any means guaranteed to get any of the above conditions if you have migraine.

However, it does increase your risk significantly enough for researchers to take notice. And if you have other risk factors, you should think about how to lower your risk.

These types of studies not only help us measure our risk, they also help us understand migraine. Researchers are trying to delve into why migraine and heart disease are connected, which should help us understand both better in the future.

For more information, see Migraine May Be Linked to More Cardiovascular Diseases, Study Says

Also be sure to read Migraine and Heart Disease: 7 Critical Things to Know Now