Kirill Skorobogatykh

Effects of MTHFR gene polymorphism on the clinical and electrophysiological characteristics of migraine

BackgroundIt was previously shown that the MTHFR gene polymorphism correlated with an increased risk of migraine, particularly migraine with aura. The substitution of cytosine for thymine at the position 677 of the MTHFR gene leads to formation of the thermolabile form of the protein and development of hyperhomocysteinemia, which increases the probability of migraine. The purpose of this study was to determine whether the replacement of C677T in the gene MTHFR influenced any particular symptoms of the disease.MethodsWe have analyzed clinical and electrophysiological characteristics of 83 patients with migraine (migraine with aura (MA), 19 patients, and migraine without aura (MO), 64 patients, according to the ICHD-II (2003)) taking into account their genotypes of C677T variant of MTHFR.ResultsWe have shown that MA was significantly more prevalent among the T-allele carriers (37.2%), as compared to the СС genotype patients (0%), р < 0.0001. Patients with TT genotype were not only more likely to have accompanying symptoms (significant differences were found only for photophobia), but also more sensitive to migraine attack triggers. In RP-VEP test results we observed a trend that the T-allele carriers were presented with the decreased N75/P100 amplitudes and a positive habituation index, as compared to the СС genotype patients.ConclusionsThus, according to our data, the MTHFR genotypes are associated with several clinical and electrophysiological characteristics of migraine.

Headache service quality: evaluation of quality indicators in 14 specialist-care centres

BackgroundThe study was a collaboration between Lifting The Burden (LTB) and the European Headache Federation (EHF). Its aim was to evaluate the implementation of quality indicators for headache care Europe-wide in specialist headache centres (level-3 according to the EHF/LTB standard).MethodsEmploying previously-developed instruments in 14 such centres, we made enquiries, in each, of health-care providers (doctors, nurses, psychologists, physiotherapists) and 50 patients, and analysed the medical records of 50 other patients. Enquiries were in 9 domains: diagnostic accuracy, individualized management, referral pathways, patient’s education and reassurance, convenience and comfort, patient’s satisfaction, equity and efficiency of the headache care, outcome assessment and safety.ResultsOur study showed that highly experienced headache centres treated their patients in general very well. The centres were content with their work and their patients were content with their treatment. Including disability and quality-of-life evaluations in clinical assessments, and protocols regarding safety, proved problematic: better standards for these are needed. Some centres had problems with follow-up: many specialised centres operated in one-touch systems, without possibility of controlling long-term management or the success of treatments dependent on this.ConclusionsThis first Europe-wide quality study showed that the quality indicators were workable in specialist care. They demonstrated common trends, producing evidence of what is majority practice. They also uncovered deficits that might be remedied in order to improve quality. They offer the means of setting benchmarks against which service quality may be judged. The next step is to take the evaluation process into non-specialist care (EHF/LTB levels 1 and 2).

Migraine and depression: a comparative assessment of the efficacy and safety of antidepressants in patients with migraine

A migraine is a primary headache disorder that is associated with more years of disability than any other neurological condition.1 Episodic migraine (attacks on less than 15 days a month) and chronic migraine (headache on 15 or more days a month over more than 3 months) are distinguished.2 The progression from episodic migraine to chronic migraine (a process called transformation) occurs in approximately 2% of patients with episodic migraine each year.3 Epidemiological studies have identified a number of modifiable and non-modifiable risk factors for the progression to chronic migraine.4 Modifiable risk factors include depression, anxiety, stressful events, obesity, sleep disorders, snoring, excessive consumption of caffeine, excessive consumption of analgesics, and cutaneous allodynia.5,6 The state-of-the-art prevention and treatment programmes for chronic migraine are primarily directed to target modifiable risk factors, because chronic migraine is characterized by worse maladaptation, low quality of life, higher need for medical assistance, and greater occurrence of comorbid somatic and psychiatric diseases, including depression, as compared with episodic migraine.5,7–9 Depression is a psychiatric disease; its main characteristic is low mood. A diagnosis of a depressive episode (ICD-10) requires the presence of two major symptoms and at least three minor symptoms (Table 1).10

EHMTI-0233. Clinical characteristics of migraine patients with dopaminergic gene polymorphisms RS1611115

The dopaminergic system plays a major role in migraine. Dopamine beta hydroxylase (DBH) is responsible for maintaining dopamine-to-norepinephrine ratio implicated in migraine pathophysiology. We aimed to look for association of polymorphisms in dopaminergic genes in genetic susceptibility to migraine in Russian population. In the present study DBH polymorphisms rs1611115 was selected. The aim of this study was to determine whether the polymorphisms rs1611115 in DBH gene influenced any particular symptoms of the disease.

EHMTI-0208. Positive association between -1021C/T polymorphism of dopamine-b-hydroxylase gene and level substance dependence in medication-overuse headache

Results The genotype frequencies of -1021C/T polymorphism DBH gene did not differ between the MOH and other groups. In contrast, we found that the presence of the -1021T allele was significantly associated with the monthly drug consumption and LDQ total score in the MOH group. We also found an interaction between the presence of DBH -1021T genotype and efficiency serotonin-norepinephrine reuptake inhibitors in patient with MOH. Conclusions