Spotlight on Migraine in childhood

Childhood migraine is common, affecting 4% of children. Migraine in children commonly causes bilateral or midfrontal headaches. The peak incidence for migraine in males of all ages is 10 to 14 years, and for females, it is 20 to 24 years. The biggest concerns parents have regarding the etiology of childhood headaches are brain tumors or vascular problems, particularly aneurysms. However, when the exam is normal and the headaches are episodic, these concerns are usually unwarranted. The CHAMP trial has led some clinicians to question the utility of pharmacological treatment for migraine. However, many pharmacological approaches are still warranted. In addition, alternative treatments, including acupuncture, biofeedback, and nutraceuticals, have not been adequately studied to show efficacy. The benefit of a healthy lifestyle to treat acute migraine and to forestall chronic migraine is increasingly recognized. For chronic migraine, one treatment to be considered is injection of the greater occipital nerve. In this article, Dr. Raymond Kandt of Johns Hopkins University reviews the clinical manifestations and discusses treatment strategies.

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Spotlight on Migraine: psychiatric comorbidities

Psychiatric conditions, especially mood, anxiety, and personality disorders, are common in persons suffering from migraine. These psychiatric comorbidities can alter the clinical course of migraine, its prognosis, and the quality of life of the sufferers. Therefore, diagnosis and treatment of these coexisting conditions are crucial parts of managing persons with migraine. In this article, the authors review the recent findings as well as summarize the key concept of the association between migraine and these psychiatric conditions.

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Spotlight on Headache in transplant patients

In this article, discusses the approach to headache when presenting in the context of solid organ or hematopoietic stem cell transplant patients, which can include both primary and secondary causes. In this article, Dr. Jeniffer Robblee of Barrow Neurological Institute outlines the epidemiology and etiologies of headache in the transplant population including pharmacotherapies, infection, vascular associations, and miscellaneous causes. Suggestions for management and possible pathophysiological mechanisms are discussed.

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Spotlight on Cyclic vomiting syndrome

In this article, Dr. Shannon Babineau of Goryeb Children’s Hospital discusses cyclic vomiting syndrome, which is considered one of the functional abdominal disorders and migraine variants. It is typified by stereotyped intense bouts of vomiting, at least 4 times per hour, lasting for hours to days followed by stretches of wellness. It has been recognized in children for over 100 years and it is being recognized as a condition that affects adults as well. Its pathophysiology is still not well understood; however, identification of autonomic and mitochondrial dysfunction has helped towards a better understanding.

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Spotlight on Medication overuse headache

Medication overuse headache is a chronic headache that occurs in people with a pre-existing primary headache, such as migraine or tension-type headache, following overuse of any kind of acute headache medications. It is a common and disabling disorder that affects 1% to 2% of the general population, and it is extremely important to recognize and treat this condition. Generally, treatment of medication overuse headache requires a multidisciplinary setting and includes education of patients, discontinuation of the overused medication, and initiation of preventive treatment.

In this recently updated article, Dr. Chia-Chun Chiang of the University of California, San Diego provides an update on the definition, pathophysiology, clinical aspects, and treatment strategies of this headache type.

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Spotlight on Recurrent painful ophthalmoplegic neuropathy

In this article, Dr. Deborah Friedman of the University of Texas Southwestern Medical Center discusses the fascinating and controversial entity of recurrent painful ophthalmoplegic neuropathy, formerly termed “ophthalmoplegic migraine.” The International Classification of Headache Disorders (ICHD-3 beta+) no longer considers the disorder a type of migraine but has reclassified it as a cranial neuralgia.

Although many cases are typical of a cranial neuralgia, with enhancement of the involved cranial nerve on MRI and improvement using corticosteroids, other cases are more suggestive of a migraine variant. The third nerve is the nerve most frequently involved, and most cases appear in childhood or early adulthood. The episodes of ophthalmoplegia appear spontaneously and then resolve. As the etiology for recurrent painful ophthalmoplegic neuropathy is likely multifactorial and remains uncertain, the condition may more appropriately be considered a syndrome rather than a distinct diagnosis.

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Spotlight on Patent foramen ovale

In this article, Dr. Shadi Yaghi and Dr. Shawna Cutting of the Warren Alpert Medical School of Brown University discuss patent foramen ovale, a highly prevalent anomaly occurring in 25% to 30% of the general population.

Patent foramen ovale represents the postnatal persistence of the normally present foramen ovale, a flap valve structure formed by the septum primum and septum secundum in the fetus. Although it is generally asymptomatic, studies have found associations with ischemic stroke and migraine. The best treatment strategy for patent foramen ovale in the setting of ischemic stroke or migraine remains unclear. Randomized controlled trials on patent foramen ovale closure showed no benefit for secondary stroke prevention or migraine improvement.

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Spotlight on Status migrainosus

In this article, Dr. Shuhan Zhu of Jefferson Headache Center discusses status migrainosus, an attack of severe migraine lasting more than 72 hours accompanied by debilitating symptoms that is not attributable to another disorder.

Status migrainosus may occur in migraineurs with or without aura. For patients presenting with the first or worst prolonged headache, a thorough neurologic evaluation with collateral imaging and/or spinal fluid sampling is indicated to assess for secondary causes of pain. In a patient with underlying diagnosis of migraine and without a secondary attributable cause of prolonged headaches, focus should be on swift and effective treatment with the primary aim of aborting the migraine.

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Spotlight on Migraine aura without headache

Migraine is a common neurologic disorder that is prevalent in the younger population. With age, migraine prevalence decreases, but some people continue to experience migraine auras without the subsequent or associated headache pain. In this article, Dr. Shih-Pin Chen of the National Yang-Ming University School of Medicine reviews the clinical manifestations, prevalence, pathophysiology, therapeutic options, and prognosis for this selective group of patients. Breakthroughs in understanding the pathogenesis and clinical manifestations are highlighted.

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Spotlight on Retinal migraine

In this article, Dr. Brian Grosberg and Dr. Seymour Solomon, both of Albert Einstein College of Medicine and Montefiore Headache Center, discuss clinical manifestations, biological basis, and prognosis of retinal migraine.

Retinal migraine is usually characterized by attacks of fully reversible monocular visual loss associated with migraine headache. Retinal migraine is most common in women of childbearing age who have a history of migraine with aura. In the typical attack, monocular visual features consist of partial or complete visual loss lasting less than 1 hour. Although the current diagnostic criteria for retinal migraine require fully reversible visual loss, our findings suggest that irreversible visual loss is part of the retinal migraine spectrum. Nearly half of reported cases with recurrent transient monocular visual loss subsequently experienced permanent monocular visual loss.

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