Kjersti Grøtta Vetvik

Sex differences in the epidemiology, clinical features, and pathophysiology of migraine

Migraine is two to three times more prevalent in women than men, and women report a longer attack duration, increased risk of headache recurrence, greater disability, and a longer period of time required to recover. Conditions recognised to be comorbid with migraine include asthma, anxiety, depression, and other chronic pain conditions, and these comorbidities add to the amount of disability in both sexes. Migraine-specifically migraine with aura-has been identified as a risk factor for vascular disorders, particularly in women, but because of the scarcity of data, the comparative risk in men has yet to be established. There is evidence implicating the role of female sex hormones as a major factor in determining migraine risk and characteristics, which accounts for sex differences, but there is also evidence to support underlying genetic variance. Although migraine is often recognised in women, it is underdiagnosed in men, resulting in suboptimal management and less participation of men in clinical trials.

Brief intervention for medication-overuse headache in primary care. The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial

Background Medication-overuse headache (MOH) is common in the general population. We investigated effectiveness of brief intervention (BI) for achieving drug withdrawal in primary care patients with MOH. Methods The study was double-blind, pragmatic and cluster-randomised controlled. A total of 25 486 patients (age 18–50) from 50 general practitioners (GPs) were screened for MOH. GPs defined clusters and were randomised to receive BI training (23 GPs) or to continue business as usual (BAU; 27 GPs). The Severity of Dependence Scale was applied as a part of the BI. BI involved feedback about individual risk of MOH and how to reduce overuse. Primary outcome measures were reduction in medication and headache days/month 3 months after the intervention and were assessed by a blinded clinical investigator. Results 42% responded to the postal screening questionnaire, and 2.4% screened positive for MOH. A random selection of up to three patients with MOH from each GP were invited (104 patients), 75 patients were randomised and 60 patients included into the study. BI was significantly better than BAU for the primary outcomes (p<0.001). Headache and medication days were reduced by 7.3 and 7.9 (95% CI 3.2 to 11.3 and 3.2 to 12.5) days/month in the BI compared with the BAU group. Chronic headache resolved in 50% of the BI and 6% of the BAU group. Conclusions The BI method provides GPs with a simple and effective instrument that reduces medication-overuse and headache frequency in patients with MOH. Trial registration number NCT01314768.

Prevalence of menstrual migraine: A population-based study:

Aim To present data from a population-based epidemiological study on menstrual migraine. Material and methods Altogether, 5000 women aged 30–34 years were screened for menstrual migraine. Women with self-reported menstrual migraine in at least half of their menstrual cycles were invited to an interview and examination. We expanded the International Classification of Headache Disorders III beta appendix criteria on menstrual migraine to include both migraine without aura and migraine with aura, as well as probable menstrual migraine with aura and migraine without aura. Results A total of 237 women were included in the study. The prevalence among all women was as follows: any type of menstrual migraine 7.6%; menstrual migraine without aura 6.1%; menstrual migraine with aura 0.6%; probable menstrual migraine without aura 0.6%; probable menstrual migraine with aura 0.3%. The corresponding figures among female migraineurs were: any type of menstrual migraine 22.0%, menstrual migraine without aura 17.6%, menstrual migraine with aura 1.7%, probable menstrual migraine without aura 1.6% and probable menstrual migraine with aura 1.0%. Conclusion More than one of every five female migraineurs aged 30–34 years have migraine in ≥50% of menstruations. The majority has menstrual migraine without aura and one of eight women had migraine with aura in relation to their menstruation. Our results indicate that the ICHD III beta appendix criteria of menstrual migraine are not exhaustive.

Contraceptive-induced amenorrhoea leads to reduced migraine frequency in women with menstrual migraine without aura

BackgroundMenstrual migraine without aura (MM) affects approximately 20% of female migraineurs in the general population. The aim of the present study was to investigate the influence of contraception on the attacks of migraine without aura (MO) in women with MM.Findings141 women from the general population with a history of MM according to the International Classification of Headache Disorders II (ICHD II) were interviewed by a headache specialist. Of 49 women with a history of MM currently using hormonal contraception, 23 reported amenorrhoea. Significantly more women with amenorrhoea reported no MO- days during the preceding month compared to women without amenorrhoea (OR 16.1; 95% confidence interval (CI) 1.8-140.4; P = 0.003). A reduction of MO-frequency was more often reported in women with than without amenorrhoea (OR 3.5; 95% CI 1.1-11.4; P = 0.04).ConclusionAmenorrhoea leads to a reduction of MO-frequency in women with MM using hormonal contraceptives. Future prospective studies on MM should focus on contraceptive methods that achieve amenorrhoea.

Menstrual versus non-menstrual attacks of migraine without aura in women with and without menstrual migraine

Objective The objective of this article is to compare clinical characteristics of menstrual and non-menstrual attacks of migraine without aura (MO), prospectively recorded in a headache diary, by women with and without a diagnosis of menstrual migraine without aura (MM) according to the International Classification of Headache Disorders (ICHD). Material and methods A total of 237 women from the general population with self-reported migraine in ≥50% of their menstrual periods were interviewed and classified by a physician according to the criteria of the ICHD II. Subsequently, all participants were instructed to complete a prospective headache diary for at least three menstrual cycles. Clinical characteristics of menstrual and non-menstrual attacks of MO were compared by a regression model for repeated measurements. Results In total, 123 (52%) women completed the diary. In the 56 women who were prospectively diagnosed with MM by diary, the menstrual MO-attacks were longer (on average 10.65 hours, 99% CI 3.17–18.12) and more frequently accompanied by severe nausea (OR 2.14, 99% CI 1.20–3.84) than non-menstrual MO-attacks. No significant differences between menstrual and non-menstrual MO-attacks were found among women with MO, but no MM. Conclusion In women from the general population, menstrual MO-attacks differ from non-menstrual attacks only in women who fulfil the ICHD criteria for MM.

A clinical interview versus prospective headache diaries in the diagnosis of menstrual migraine without aura.

Objectives The objective of this article is to compare the diagnosis of menstrual migraine without aura (MM) from a clinical interview with prospective headache diaries in a population-based study. Material and methods A total of 237 women with self-reported migraine in at least half of menstruations were interviewed by a neurologist about headache and diagnosed according to the International Classification of Headache Disorders II (ICHD II). Additionally, the MM criteria were expanded to include other types of migraine related to menstruation. Subsequently, all women were asked to complete three month prospective headache diaries. Results A total of 123 (52%) women completed both clinical interview and diaries. Thirty-eight women were excluded from the analyses: Two had incomplete diaries and 36 women recorded ≤1 menstruation, leaving 85 diaries eligible for analysis. Sensitivity, specificity, positive and negative predictive value and Kappa for the diagnosis of MM in clinical interview vs. headache diary were 82%, 83%, 90%, 71% and 0.62 (95% CI 0.45–0.79). Using a broader definition of MM, Kappa was 0.64 (95% CI 0.47–0.83). Conclusion A thorough clinical interview is valid for the diagnosis of MM. When this is undertaken, prospective headache diaries should not be mandatory to diagnose MM but may be necessary to exclude a chance association.

Are Menstrual and Nonmenstrual Migraine Attacks Different

Migraine is the second most common headache condition next to tension-type headache. Up to one fourth of all women have migraine, and 20% of them experience migraine without aura attack in at least two thirds of their menstrual cycles. The current literature is analyzed in response to the question of whether menstrual and nonmenstrual migraine attacks are different. The different studies provide conflicting results, so it is not possible to answer the question firmly. Future studies should be based on the general population. Collection of both prospective and retrospective data is warranted, and headache diagnosis base on interviews by physicians with interest in headache are more precise than lay interviews or questionnaires.

EHMTI-0251. Brief intervention for medication-overuse headache in primary care - 1-year follow-up – the BIMOH study.

MOH can be identified in the general population through simple screening for headache frequency followed by the Severity of Dependence Scale (SDS).

EHMTI-0228. A clinical interview versus prospective headache diaries in the diagnosis of menstrual migraine without aura

The International Classification of Headache Disorders (ICHD) II and III beta defines menstrual migraine as attacks of migraine without aura occurring on day 1±2 of the menstrual cycle in ≥2/3 menstruations. According to the ICHD III beta, a three month prospective headache diary is required in order to establish the diagnosis of MM.

Cerebral venetrombose – forekomst, diagnostikk og behandling

E-mail: e.s.kristoffersen@medisin.uio.no Department of Neurology Akershus University Hospital and Department of General Practice Institute of Health and Society University of Oslo He is the first author and had the original idea for the manuscript. He has contributed academically and scientifically, with revision of the manuscript, literature searches and data interpretation. Espen Saxhaug Kristoffersen (born 1980), PhD, specialty registrar in neurology, and associate professor. The author has completed the ICMJE form and reports no conflicts of interest.