Cerebrovascular Reactivity Measures Are Associated With Post-traumatic Headache Severity in Chronic TBI; A Retrospective Analysis (original) (raw)
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Persistent Post-Traumatic Headache and Migraine: Pre-Clinical Comparisons
International Journal of Environmental Research and Public Health, 2020
Background: Oftentimes, persistent post traumatic headache (PPTH) and migraine are phenotypically similar and the only clinical feature that differentiate them is the presence of a mild or moderate traumatic brain injury (mTBI). The aim of this study is to describe the differences in brain area and in biochemical cascade after concussion and to define the efficacy and safety of treatments in use. Methods: Sources were chosen in according to the International Classification of Headache Disorder (ICHD) criteria. Results: The articles demonstrated a significant difference between PPTH and migraine regarding static functional connectivity (sFC) and dynamic functional connectivity (dFC) in brain structure that could be used for exploring the pathophysiological mechanisms in PPTH. Many studies described a cascade of neuro-metabolic changes that occur after traumatic brain injury. These variations are associated to the mechanism occurring when developing a PPTH. Conclusions: The state of a...
BMC Neurology, 2011
Background: There is a growing interest in the role of the endothelium in migraine. Recently, our group showed differences in endothelial function between the anterior and posterior cerebral circulation in healthy subjects, reduced vasodilatatory capacity of the posterior cerebral circulation and unimpaired systemic endothelial function in migraine patients without comorbidities. However, the relationship between cerebral and systemic endothelial function and the anterior and posterior cerebral endothelial function in migraine patients is still not clear. Methods: We compared cerebral and systemic endothelial function through post-hoc linear regression analysis of cerebrovascular reactivity (CVR) to L-arginine between the middle cerebral artery (MCA) and flow-mediated vasodilatation (FMD) of the right brachial artery and the posterior cerebral artery (PCA) and FMD in migraine patients without comorbidities and in healthy subjects. The anterior and posterior cerebral endothelial function was also compared using post-hoc linear regression analysis between CVR to L-arginine in the MCA and the PCA. Results: No significant correlation was found between CVR to L-arginine in the MCA and FMD and in the PCA and FMD in migraine patients with aura (p = 0.880 vs. p = 0.682), without aura (p = 0.153 vs. p = 0.179) and in healthy subjects (p = 0.869 vs. p = 0.662). On the other hand, we found a significant correlation between CVR to L-arginine in the MCA and PCA in migraine patients with aura (p = 0.004), without aura (p = 0.001) and in healthy subjects (p = 0.002). Detailed analysis of the linear regression between all migraine patients and healthy subjects did not show any difference in the regression coefficient (slope) (p = 0.382). However, a significant difference in curve elevation (intercept) was found (p = 0.002). Conclusions: Our study suggests that the endothelial function in the cerebral and systemic circulation might be different in migraine patients without comorbidities, while that of the anterior and posterior cerebral circulation might be coupled. These results could improve understanding of endothelial function in migraine patients without comorbidities.
Pathophysiological links between traumatic brain injury and post-traumatic headaches
F1000Research, 2016
This article reviews possible ways that traumatic brain injury (TBI) can induce migraine-type post-traumatic headaches (PTHs) in children, adults, civilians, and military personnel. Several cerebral alterations resulting from TBI can foster the development of PTH, including neuroinflammation that can activate neural systems associated with migraine. TBI can also compromise the intrinsic pain modulation system and this would increase the level of perceived pain associated with PTH. Depression and anxiety disorders, especially post-traumatic stress disorder (PTSD), are associated with TBI and these psychological conditions can directly intensify PTH. Additionally, depression and PTSD alter sleep and this will increase headache severity and foster the genesis of PTH. This article also reviews the anatomic loci of injury associated with TBI and notes the overlap between areas of injury associated with TBI and PTSD.
Annals of clinical and translational neurology, 2018
Traumatic cerebrovascular injury (TCVI), a common consequence of traumatic brain injury (TBI), presents an attractive therapeutic target. Because phosphodiesterase-5 (PDE5) inhibitors potentiate the action of nitric oxide (NO) produced by endothelial cells, they are candidate therapies for TCVI. This study aims to: (1) measure cerebral blood flow (CBF), cerebrovascular reactivity (CVR), and change in CVR after a single dose of sildenafil (ΔCVR) in chronic TBI compared to uninjured controls; (2) examine the safety and tolerability of 8-week sildenafil administration in chronic symptomatic moderate/severe TBI patients; and as an exploratory aim, (3) assess the effect of an 8-week course of sildenafil on chronic TBI symptoms. Forty-six subjects (31 chronic TBI, 15 matched healthy volunteers) were enrolled. Baseline CBF and CVR before and after administration of sildenafil were measured. Symptomatic TBI subjects then completed an 8-week double-blind, placebo-controlled, crossover trial ...
2014
: Our proposal studies the natural history and mechanisms of increased brain excitability leading to migraine and epilepsy after traumatic brain injury. In the 30 months since this grant was funded, we have completed experiments spanning nearly the whole range of our proposed work. The most important milestones in this project year have been: 1. Continued successful implementation of very challenging post-TBI in vivo two-photon imaging and in vivo whole cell recording, with manuscript in preparation of novel TBI-specific phenotypes from our in vivo whole cell recordings. 2. Novel findings from two-photon recordings. 3. Novel findings from recording of acute and chronic remote telemetry datasets. 4. Progressive implementation of histological techniques. 5. Collection of post-TBI behavioral datasets. 6. Publication of the preliminary data for this grant in Stroke.
Examining the association between traumatic brain injury and headache
Journal of Integrative Neuroscience, 2021
Traumatic brain injury is a common and major cause of disability and death that might require emergency neurological and neurosurgical interventions. Traumatic brain injury can result in temporary or permanent physical, cognitive and psychological impairments. One of the most common complications associated with traumatic brain injury is post-traumatic headache, associated with significant disability and reduced quality of life. Post-traumatic headache is a public health concern that can affect the long-term outcome of traumatic brain injury patients. Clinical symptoms of post-traumatic headache significantly overlap with common primary headaches such as migraine and tension-type headaches. Beyond neurobiological factors, psychological factors can play crucial roles in the initiation and sustainment of post-traumatic headache. While neurological mechanisms underlying post-traumatic headache remains unknown, different studies suggest various mechanisms such as physical damages to the cranial nerves and neck structure, hyper-sensitization of the pain modulatory pathway, and inflammation as underlying causes for the neurobiology of headache. I explore the hypothesis that traumatic brain injury is associated with headaches. In particular, I provide an overview of the neurobiology of post-traumatic headache, its diagnosis, presenting recent findings on the etiology, explaining similarities and differences between with primary headaches such as migraine and tension-type headache, discuss pharmacological and non-pharmacological interventions for the treatments, as well as emphasising on the psychological importance of post-traumatic headache.
Cerebral blood flow in migraine accompaniments and vertebrobasilar ischemia
Stroke, 1994
Transient neurological symptoms of brain stem or occipital lobe origin may be caused by transient ischemic attack in the vertebrobasilar territory (VB-TIA) or late-onset (or late-life) migraine accompaniment (LOMA). It is often clinically difficult to distinguish between VB-TIA and LOMA. Cerebral blood flow of 23 patients with VB-TIA, 24 with LOMA, and 28 age-matched control subjects was measured using the 133Xe inhalation regional cerebral blood flow (rCBF) technique. After adjusting for differences in baseline variables such as blood pressure, hematocrit, and PCO2, patients with VB-TIA had (1) lower mean rCBF than control subjects (P < .003) as measured by the initial slope index method; (2) more frequent anterior rCBF asymmetries than control subjects and patients with LOMA (P < .03 for both comparisons); and (3) higher mean interhemispheric rCBF differences compared with patients with LOMA (P = .08) and control subjects (P < .02). Regional CBF patterns in patients with ...
Vulnerability to Infarction During Cerebral Ischemia in Migraine Sufferers
Stroke, 2018
Cerebral hyperexcitability in migraine experiencers might sensitize brain tissue to ischemia. We investigated whether a personal history of migraine is associated with vulnerability to brain ischemia in humans. Multicenter cohort study of patients with acute ischemic stroke who underwent a brain computed tomography perfusion and were scheduled to undergo reperfusion therapy. In a case-control design, we compared the proportion of subjects with no-mismatch, the volume of penumbra salvaged, as well as the final infarct size in a group of patients with migraine and a group of patients with no history of migraine. We included 61 patients with migraine (34 [55.7%] men; mean age, 52.2±15.1 years; migraine without aura/migraine with aura, 44/17) and 61 patients with no history of migraine. The proportion of no-mismatch among migraineurs was significantly higher than among nonmigraineurs (17 [27.9%] versus 7 [11.5%];=0.039) and was more prominent among patients with migraine with aura (6 [3...
Vascular Risk in Migraineurs: Interaction of Endothelial and Cortical Excitability Factors
Headache: The Journal of Head and Face Pain, 2014
Background.-Migraine is a common primary headache disorder occurring predominantly in a young, relatively healthy population. Results.-There is a growing literature on associations between migraine, especially migraine with aura, and ischemic stroke as well as other vascular events. Migraine as a risk factor for vascular disease and connections between migraine and endothelial, structural, and genetic risk are reviewed. Conclusion.-There may be an interaction between endothelial dysfunction and cortical spreading depression affecting risk. Patient education and treatment of modifiable risk factors may decrease future vascular events.
Correlations Between Endothelial Dysfunction and Cerebral Imaging in Migraine
Turkish Journal Of Neurology, 2019
Objective: Despite its high prevalence, the basic pathophysiologic mechanism of migraine is still poorly understood. Our aim was to research endothelial dysfunction in patients with recently diagnosed episodic migraine, and to determine whether there was a correlation between endothelial dysfunction and white matter lesions (WMLs) on magnetic resonance imaging (MRI). Materials and Methods: This study was conducted between 2013 and 2014. A total of 51 patients and 27 healthy controls were included in the study. MRI was performed in the patient group. Blood samples were collected to investigate serum level of lipids, thyroid hormones, asymmetric dimethyl arginine, and endothelin levels in the patient and control groups. Homeostasis model assessment = insulin resistance factor and brachial artery index flow-mediated dilatation (FMD) were investigated in both groups. Results: WMLs on MRI were present in 40 patients with migraine. FMD was low in patients with migraine (p=0.021). There was a negative correlation between the severity of migraine headache and FMD. A positive correlation was seen between severity of headache and WMLs (p=0.001). The other blood sample concentrations in both the case and control groups were not significantly different. When the blood parameters were evaluated with MRI lesion load, there was a positive correlation with age, cholesterol, low-density lipoprotein, body mass index and triglyceride, and contrary to expectations, there was no relationship with homocysteine. However, there was a significant correlation between insulin resistance and lesion load (p<0.03). Conclusion: In this study, especially in patients with episodic migraine with WMLs, FMD as a marker for endothelial dysfunction was found to be statistically significant. This finding contributes to the pathogenesis of migraine. An endothelial therapeutic drug could be considered as an option, especially in patients who need prophylaxis.