Headaches and von willebrand disease (original) (raw)
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Association of von Willebrand factor activity with ACE I/D and MTHFR C677T polymorphisms in migraine
Cephalalgia, 2009
Angiotensin-converting enzyme (ACE) insertion (I)/deletion (D) and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphisms are linked to endothelial dysfunction and to cerebral white matter lesions. Objectives of this study were to determine if ACE and MTHFR gene polymorphisms are associated with von Willebrand factor (vWF) activity, an endothelial dysfunction marker, and with a distinct headache phenotype. We enrolled 64 women (18-50 years old) with International Classification of Headache Disorders, 2nd edn migraine without aura (MoA) and 61 with aura (MA). Genotypic frequencies: ACE DD 35%, ID 42%, II 23%, and MTHFR TT 17%, CT 40%, CC 43%. Those with ACE DD genotype had higher levels of vWF activity (152%) compared with ID and II genotypes. Levels were highest (179%) with combined ACE DD and MTHFR TT genotypes. ACE DD was associated with higher headache frequency, and MTHFR TT was associated with MA. In migraine, vWF activity may be a marker of endothelial-mediated genetic risk for ischaemic conditions. ᮀ Migraine, von Willebrand factor, endothelial dysfunction, angiotensin-converting enzyme, methylenetetrahydrofolate reductase
Migraine and cardiovascular disease: Possible mechanisms of interaction
Neurology, 2009
Migraine, especially migraine with aura (MA), is an established risk factor for ischemic lesions of the brain. Recent evidence has also linked migraine to a broader range of ischemic vascular disorders including angina, myocardial infarction, coronary revascularization, claudication, and cardiovascular mortality. The mechanisms which link migraine to ischemic vascular disease remain uncertain and are likely to be complex. Cortical spreading depression, the presumed substrate of aura, may directly predispose to brain lesions and that would explain why MA is consistently demonstrated as a risk factor for cerebral ischemia, while for migraine without aura (MO), the evidence is less consistent. Additionally, individuals with migraine have a higher prevalence of risk factors known to be associated with cardiovascular disease (CVD), including hypertension, diabetes, and hyperlipidemia. The increased prevalence of CVD risk factors is also higher for MA than for MO. Since the evidence linking migraine and CVD is getting robust, neurologists should be aware of this association. Individuals with MO seem to be at little increased risk of CVD. MA is associated with an increased risk of ischemic stroke and likely also for other ischemic CVD events. Accordingly, heightened vigilance is recommended for modifiable cardiovascular risk factors in migraineurs, especially with MA. Ultimately, it will be important to determine whether MA is a modifiable risk factor for CVD and if preventive medications for migraine or antiplatelet therapy might reduce the risk of CVD in patients with MA. Neurology ® 2009;72:1864-1871 GLOSSARY BMI ϭ body mass index; CDH ϭ chronic daily headache; CI ϭ confidence interval; CSD ϭ cortical spreading depression; CVD ϭ cardiovascular disease; EPC ϭ endothelial progenitor cells; HR ϭ hazard ratio; MA ϭ migraine with aura; MMP ϭ matrix metalloproteinase; MO ϭ migraine without aura; MTHFR ϭ methyltetrahydrofolate reductase; RR ϭ relative risk.
Background: Migraine headache is a neurologic disorder which mainly affects younger and productive segment of population. Migraine not only causes pain; but also affects quality of life in terms of low productivity and economic loss. The main aim of this study was to examine migraine-related disability, co-morbid depression, and relationship between the two. Methods: A cross-sectional study was conducted among migraineurs who visited two neurology referral clinics. The study was conducted between June 1st 2016 to December 30 th 2016. Migraine disability assessment score [MIDAS] and patient health questionnaire [PHQ-9] were used to assess disability and depression, respectively. Results: A total of 70 patients participated in the study. Fifty-three (74.3%) of our study participants were women. Fifty one (72.9%) study participants were between age group 20-40 years. Migraine without aura was the most common subtype (70%); migraine with aura accounted for the other 28.6%. The mean (± SD) headache frequency and intensity was 23.4 ± 14.9 days and 7.4 ± 1.2 respectively. Major depressive disorder was common in this group (41.4%). The mean MIDAS and PHQ-9 scores were 46.7 ± 30 and 9.2 ± 4.4 respectively. More than two-thirds (74.3%) of our participants had severe disability. We found a statistically significant correlation between migraine-related disability and co morbid depression among our participants(r = 0.318, p-value = 0.007). Conclusion: The positive correlation observed between migraine-related disability and co-morbid depression warrant routine screening and treatment of disability and depression in migraineurs; In addition, the observed high degree of disability among our participants may indicate sub optimal treatment of these patients.
The Levels of Circulating Proangiogenic Factors in Migraineurs
Migraine has been reported as a risk factor for ischemic stroke or cardiovascular events, and dysfunction of endothelial cells has been evidenced in migraine patients. Proangiogenic factors are potential endothelial stimulators, and their disturbances can link abnormalities of endothelium with increased risk of vascular disorders. The aim of this study was to evaluate the levels of circulating proangiogenic factors in sera of migraineurs during interictal period. Fifty-two patients aged 37.9 ± 9.6 years, fulfilling International Headache Society criteria for migraine, were included in this observational case-control study. The control group included 39 healthy volunteers, matched according to age and gender. All subjects underwent full neurological examination and clinimetric evaluation with the use of: MIDAS, MIGSEV, QVM, VAS and VRS scales. Serum concentrations of vascular endothelial growth factor (VEGF), angiogenin, angiopoietin-2, thrombopoietin and Tie-2 were estimated in migraineurs and in the control group with the use of ELISA. In migraineurs during interictal period, we have found decreased serum VEGF and angiogenin concentrations compared with controls. Age of migraine onset correlated with VEGF, angiopoietin-2 and thrombopoietin concentrations. Furthermore, angiopoietin-2 level correlated with QVM score and Tie-2 with pain intensity evaluated using MIGSEV scale. In migraine patients during interictal period, depletion of VEGF and angiogenin, two cooperating proangiogenic factors, can be responsible for endothelial dysfunction and increased risk for vascular disorders.