Gretchen E. Tietjen

Adverse Childhood Experiences and Frequent Headaches in Adults

Background.— A variety of studies have linked childhood maltreatment to headaches, including migraines, and to headache severity. This study assesses the relationship of adverse childhood experiences (ACEs) to frequent headaches during adulthood.

Migraine as a Systemic Vasculopathy

Epidemiological studies suggests that migraine is associated with disorders of the cerebral, coronary, retinal, dermal and peripheral vasculature. There is evidence that migraine is associated with endothelial dysfunction, both as a cause and a consequence. Endothelial dysfunction, a vascular risk factor, is characterized by endothelial activation and impaired vascular reactivity. Plasma and genetic biomarkers for these conditions have been identified. The clinical significance lies in the potential for the rapid identification of migraineurs at increased risk of ischaemic stroke and vascular disease through ascertainment of endothelial dysfunction biomarkers. It is uncertain whether stroke, myocardial infarction and other vasculopathies can be prevented by migraine prophylaxis, endothelial repair, platelet inhibition or a combination of these strategies.

Increased von Willebrand factor in migraine

The authors determined von Willebrand factor (vWF) in 63 persons with migraine, 11 persons with migraine and prior stroke, and 35 frequency-matched controls. Additional studies were done in a subset with migraine without aura who were headache free for >7 days. Migraineurs with prior stroke had significantly higher vWF antigen (170% versus 106%) and activity (162% versus 108%) than the control group. vWF antigen (126%) and activity (130%) were also significantly higher in migraineurs without stroke. Multimers and protease activity were normal in the interictal subset.

Migraine and Biomarkers of Endothelial Activation in Young Women

Background and Purpose— There is mounting evidence of endothelial activation and dysfunction in migraine. Our objectives were to determine in a population of premenopausal women whether endothelial activation markers are associated with migraine. Methods— Women (18 to 50 years) with and without migraine and free from cardiovascular disease were evaluated with tests of coagulation (von Willebrand factor activity, prothrombin fragment), fibrinolysis (tissue-type plasminogen activator antigen), inflammation (high-sensitivity C-reactive protein), and oxidative stress (homocysteine, total nitrate/nitrite concentrations, thiobarbituric acid–reactive substances). Results— Sixty-one participants had migraine with aura (MA), 64 had migraine without aura (MO), and 50 were controls. Compared with controls, women with migraine had higher adjusted odds ratios for elevated von Willebrand factor activity of 6.51 (95% CI, 1.94 to 21.83) in those with MA and of 4.59 (95% CI, 1.37 to 15.38) in those with MO, elevated high-sensitivity C-reactive protein of 7.99 (95% CI, 2.32 to 27.61) in those with MA and of 2.63 (95% CI, 0.73 to 9.45) in those with MO, and for lower nitrate/nitrite levels of 6.60 (95% CI, 2.06 to 21.16) in those with MA and of 3.03 (95% CI, 0.90 to 10.15) in those with MO. Within the migraine group, von Willebrand factor activity was correlated with tissue-type plasminogen activator antigen (P=0.035) and nitrate/nitrite (P=0.024). There was a trend with high-sensitivity C-reactive protein (P=0.09). Conclusions— In premenopausal women with migraine, particularly in those with MA, there is evidence of increased endothelial activation, a component of endothelial dysfunction.

Childhood Maltreatment and Migraine (Part I). Prevalence and Adult Revictimization: A Multicenter Headache Clinic Survey

(Headache 2010;50:20‐31)

Allodynia in Migraine: Association With Comorbid Pain Conditions

Background.— Cutaneous allodynia (CA) in migraine is a clinical manifestation of central nervous system sensitization. Several chronic pain syndromes and mood disorders are comorbid with migraine. In this study we examine the relationship of migraine‐associated CA with these comorbid conditions. We also evaluate the association of CA with factors such as demographic profiles, migraine characteristics, and smoking status that may have an influence on the relationships of CA to pain and mood.

Thrombolytic therapy of acute ischemic stroke during pregnancy

The authors report eight pregnant women with acute ischemic stroke treated with thrombolysis (rt-PA [recombinant human tissue plasminogen activator] or urokinase). Seven women recovered. Two extracranial and two asymptomatic intracranial hemorrhages complicated treatment; one woman died of arterial dissection complicating angiography. Three patients had therapeutic abortions, two fetuses were miscarried, and two babies were delivered healthy. Although pregnant women may be treated safely with thrombolytics, risks and benefits to mother and fetus must be carefully weighed.

Migraine Comorbidity Constellations

Objectives.—To identify distinct constellations of comorbid disorders occurring in migraineurs, and to examine differences in demographics, headache profiles, and psychosocial features between the comorbidity constellations.

Post‐Traumatic Stress Disorder in Episodic and Chronic Migraine

Objective.— To assess and contrast the relative frequency of self‐reported post‐traumatic stress disorder (PTSD) in patients with episodic migraine and chronic/ transformed migraine.

Childhood maltreatment and migraine (part III). Association with comorbid pain conditions.

(Headache 2010;50:42‐51)