Displaying publications 1 - 20 of 37 in total

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  1. Huang P, Kuo PH, Lee MT, Chiou LC, Fan PC
    Front Pharmacol, 2018;9:1095.
    PMID: 30319425 DOI: 10.3389/fphar.2018.01095
    Background: Valproic acid (VPA) and topiramate (TPM), initially developed as antiepileptics, are approved for migraine prophylaxis in adults but not children. The differences in their antimigraine mechanism(s) by age remain unclear. Methods: A migraine model induced by intra-cisternal (i.c.) capsaicin instillation in pediatric (4-5 weeks) and adult (8-9 weeks) rats was pretreated with VPA (30, 100 mg/kg) or TPM (10, 30, 100 mg/kg). Noxious meningeal stimulation by the irritant capsaicin triggered trigeminovascular system (TGVS) activation mimicking migraine condition, which were assessed peripherally by the depletion of calcitonin gene-related peptide (CGRP) in sensory nerve fibers of the dura mater, the increased CGRP immunoreactivity at trigeminal ganglia (TG) and centrally by the number of c-Fos-immunoreactive (c-Fos-ir) neurons in the trigeminocervical complex (TCC). Peripherally, CGRP released from dural sensory nerve terminals of TG triggered pain signal transmission in the primary afferent of trigeminal nerve, which in turn caused central sensitization of the TGVS due to TCC activation and hence contributed to migraine. Results: In the VPA-treated group, the central responsiveness expressed by reducing the number of c-Fos-ir neurons, which had been increased by i.c. capsaicin, was significant in pediatric, but not adult, rats. Inversely, VPA was effective in peripheral inhibition of elevated CGRP immunoreactivity in the TG and CGRP depletion in the dura mater of adult, but not pediatric, rats. In TPM group, the central responsiveness was significant in both adult and pediatric groups. Peripherally, TPM significantly inhibited capsaicin-induced CGRP expression of TG in adult, but not pediatric, rats. Interestingly, the capsaicin-induced depletion of CGRP in dura was significantly rescued by TPM at high doses in adults, but at low dose in pediatric group. Conclusion: These results suggest VPA exerted peripheral inhibition in adult, but central suppression in pediatric migraine-rats. In contrast, TPM involves both central and peripheral inhibition of migraine with an optimal therapeutic window in both ages. These findings may clarify the age-dependent anti-migraine mechanism of VPA and TPM, which may guide the development of new pediatric anti-migraine drugs in the future.
    Matched MeSH terms: Migraine Disorders
  2. Rahman A, Segasothy M, Samad SA, Zulfiqar A, Rani M
    Headache, 1993 Sep;33(8):442-5.
    PMID: 8262786
    The pattern of analgesic use, abuse and incidence of analgesic-associated nephropathy in 79 patients with chronic headache was studied. Sixty-eight of these patients had migraine. Most patients had consumed a combination of analgesics (81%) while 19% had taken single analgesics for their headache. Nonsteroidal anti-inflammatory drugs were the most commonly used analgesics (96.2%) followed by paracetamol (70.9%) and aspirin, phenacetin and caffeine compounds (5.1%). Mefenamic acid was the commonest nonsteroidal anti-inflammatory drug consumed (97.4%). Analgesic abuse which was defined as a minimum total of 1 kg of analgesics such as paracetamol or aspirin, phenacetin and caffeine compounds or 400 capsules/tablets of nonsteroidal anti-inflammatory drugs was noted in 65 patients. Nonsteroidal anti-inflammatory drugs were the most commonly abused analgesics (89.2%) followed by paracetamol (38.5%). Forty-five of the 65 analgesic abusers had an intravenous urogram or ultrasound performed and renal papillary necrosis was documented in one patient. Three (4.6%) of the analgesic abusers had mildly raised serum creatinine levels. Mild proteinuria of less than 1 gm/litre was present in 27.7% of abusers. In conclusion, although analgesic use and abuse is common in patients with chronic headache, the short term incidence of analgesic-associated nephropathy (2.2%) and renal impairment (4.6%) was low. Prolonged observations will be necessary to ascertain the safety of these drugs for long term use.
    Matched MeSH terms: Migraine Disorders/drug therapy*
  3. Kam CS
    Med J Malaysia, 1982 Mar;37(1):14-7.
    PMID: 7121341
    This is a report of clinical features of migraine in Malaysians. Seventeen migraineurs were studied with respect to age, sex, length of disease, headache, aura, nausea, frequency, remission, precipitating factors, relieving factors, family history, coexisting symptoms, coexisting disease, and type of migraine. Similarities and differences between Malaysian and Caucasian migraineurs are discussed.
    Matched MeSH terms: Migraine Disorders*
  4. Kay, Sin Tan, Navarro, Jose C, Ka, Sing Wong, Yi, Ning Huang, Hou, Chang Chiu, Poungvarin, Niphon, et al.
    Neurology Asia, 2014;19(2):117-127.
    MyJurnal
    Background and Objective: There is a lack of international collaborative studies on young adults with ischaemic stroke in Asia. The aim of this study was to investigate risk factors, aetiology and outcome at hospital discharge of these patients across 8 participating countries in Asia. Methods: This was a prospective, observational, multicentre, hospital based cohort study. Consecutive young stroke patients with confirmed cerebral infarction between the ages of 18-49 were recruited from December 2011 to May 2012. Data was collected for patient demography, risk factors, investigations, clinical profile and TOAST classification. Outcome measures were death and independence (modified Rankin score≤ 2) at hospital discharge. Results: Two hundred and eighteen patients with the mean age was 40.8±6.7 years were recruited. There was a larger proportion of male patients with a ratio of 1.9:1. Traditional risk factors observed were hypertension (n=103; 47.3%), dyslipidaemia (n=93; 42.4%), smoking (n=85; 38.8%), diabetes (n=53; 24.3%), alcohol use (n=33; 15.0%), a previous history of stroke and transient ischaemic attacks (6.4%), family history (n=12; 5.5%), migraine (n=6;2.8%), pregnancy related (n=5; 2.3%) and numerous cardiac risk factors (0.9-5.5%). The majority suffered arterial infarction; n=216 (99.4%) while n=2 (0.6%) had venous strokes. The predominant stroke subtypes were large artery atherosclerosis (LAA); 29.8% and small vessel occlusion (SVO); 20.2%. LAA and SVO accounted for 37.5% of all stroke subtypes in the ≤36 year age-group. Cardioembolism (15.1%) and stroke of determined aetiology (14.7%) contributed to the other categories of identified stroke subtypes. Mortality on hospital discharge was 3.1% while 65.1% of patients were independent on discharge. Conclusion: This study demonstrated the substantial presence of premature atherosclerosis and conventional risk factors in young ischaemic stroke patients from 8 Asian cities. Venous infarction from cerebral venous thrombosis was rare in this study. Outcome on hospital discharge was poorer compared to Western studies. Detection of vascular risk factors and primary prevention measures should be initiated during late adolescence or early adulthood in urban Asia.
    Matched MeSH terms: Migraine Disorders
  5. Bhaskar S, Abdullah JM, Ghazali MM
    Neurosciences (Riyadh), 2008 Oct;13(4):356-8.
    PMID: 21063360
    OBJECTIVE: To look for any possible coexistence of CACNA1A, ATP1A2, and KCNN3 gene mutations in migraine patients who had human platelet HPA-1a/1b polymorphism, which is also known as PlA1/A2 polymorphism.
    METHODS: The study was carried out at the Neurology Clinic, Hospital University Sains Malaysia, Kelantan, Malaysia between April 2004 and March 2005. The DNA from 4 patients who had migraine with the HPA1a/1b polymorphism were analyzed by polymerase chain reaction using the allele specific oligonucleotide technique to detect the presence of CACNA1A, ATP1A2, and KCNN3 genotypes.
    RESULTS: We found that the CACNA1A gene mutation alone was present in only one patient who presented with classical migraine with aura. The gene mutations on ATP1A2 and KCNN3 were seen in none of our 4 cases with migraine.
    CONCLUSION: There is no coexistence between the platelet HPA-1a/1b polymorphism and the ATP1A2 and KCNN3 gene mutations, though one classical migraine patient with HPA-1a/1b polymorphism had the CACNA1A gene mutation. Larger studies are warranted to confirm these findings.
    Study site: Neurology Clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
    Matched MeSH terms: Migraine Disorders*
  6. Islam MA, Alam F, Wong KK
    Autoimmun Rev, 2017 May;16(5):512-522.
    PMID: 28279839 DOI: 10.1016/j.autrev.2017.03.005
    BACKGROUND: Antiphospholipid antibodies (aPLs) namely anticardiolipin (aCL) antibody, anti-β2-glycoprotein I (β2GPI) antibody and lupus anticoagulant (LA) are autoantibodies produced against anionic phospholipids and proteins on plasma membranes. Migraine is a primary headache disorder which has growing evidences of autoimmune-mediated pathogenesis and previous studies suggested the presence of aPLs in migraine patients.

    AIMS: The aim of this study was to evaluate the comorbid association between aPLs (aCL, anti-β2GPI and LA) and migraine compared to healthy controls.

    METHODS: Studies were searched through PubMed, ISI Web of Science and Google Scholar databases without restricting the languages and year (up to October 2016) and were selected based on the inclusion criteria. Two authors independently extracted data from the included studies. All analyses were conducted by using random effects model to calculate the odds ratio (OR) and 95% confidence interval (CI). Quality assessment was carried out by using the modified Newcastle-Ottawa Scale (NOS). Publication bias was evaluated via visualization of funnel plots, Begg's and Egger's tests.

    RESULTS: The database searches produced 1995 articles, 13 of which were selected (912 migraineurs and 822 healthy controls). 8.59%, 15.21% and 4.11% of the migraineurs exhibited aCL, anti-β2GPI and LA which was 4.83, 1.63 and 3.03 times higher, respectively, than healthy controls. A significant presence of aCL (OR: 3.55, 95% CI: 1.59-7.95; p=0.002) or anti-β2GPI antibodies (OR: 2.02, 95% CI: 1.20-3.42; p=0.008) was observed in migraine patients, however, LA was not significantly associated (OR: 2.02, 95% CI: 0.50-8.37; p=0.320). Majority of the studies (n=10 of 13) demonstrated NOS score of 7 or above and no significant publication bias was observed.

    CONCLUSION: Migraine might be an autoimmune-associated neurologic disorder. The presence of aCL or anti-β2GPI antibodies was significant in migraine patients compared to healthy controls, suggesting an involvement of these autoantibodies in migraine attack.
    Matched MeSH terms: Migraine Disorders/complications*
  7. Loh TG, Chawla JC
    Singapore Med J, 1972 Dec;13(6):298-304.
    PMID: 4657200
    Complicated migraine is not well known. It is associated with transient and protean sensory and motor
    nenrological features although disturbance of mood, affect and psyche has also been described.
    This paper is based on a study of ten patients suffering from complicated migraine and attempt is made
    to describe various neurological symptoms and signs.
    It becomes apparent from this study that there arc diverse manifestations of this interesting disorder.
    Furthermore complicated migraine seems to affect a younger age group and there may not be any
    family history of migraine. In most cases the nenrological symptoms precede the attacks of headaches.
    The nenrological deficit may persist after longer periods. Initially, the attacks arc usnally followed by
    complete recovery, with repeated attacks there may be residual neurological deficit. Though the exact
    aetiology of the migraine remains unknown, it has been suggested that it is due to spasm or oedema of
    cerebral vascular system. If the vessels involved are the carotid artery system, the symptoms and signs
    obviously would be due to involvement of cerebral hemisphere, whereas affection of basilar artery
    would produce signs and symptoms of cerebellar or brain stem deficiency.
    At times it may be extremely difficult to differentiate between a typical attack of migraine and headache
    due to an underlying pathology e.g. intracranial angioma or space occupying lesions, which may
    require investigations such as angiography. The angiography may prove fruitless and cause deterioration
    in neurological signs. A careful follow-up should be planned for cases with complicated migraine
    to exclude any underlying pathology.
    Matched MeSH terms: Migraine Disorders*
  8. Tai MS, Yap JF, Goh CB
    J Pain Res, 2018;11:1255-1261.
    PMID: 29988763 DOI: 10.2147/JPR.S158151
    Background: The literature on the dietary trigger factors of headache among the South East Asians is limited.
    Objective: The objective of the study was to examine the dietary trigger factors of migraine and tension-type headache (TTH) in Malaysian patients, consisting of Malays, Chinese and Indians.
    Methods: In this prospective cross-sectional study, patients presenting with migraine and TTH to a neurology clinic between April 2010 and June 2017 were recruited. The patients were given a comprehensive dietary list consisting of 25 specified types of food and drink items as well as other unspecified types of food and drink items which were possible dietary triggers. The data on these dietary triggers and missing meals were collected.
    Results: A total of 684 patients with headache (319 migraine and 365 TTH patients) were recruited. One hundred and fifty-eight (23.1%) patients had missing meals as trigger. Two hundred and fifty-five (37.3%) patients had dietary triggers; 141 (44.2%) patients with migraine and 114 (31.2%) patients with TTH had dietary triggers. Eighty-four (52.8%) Malay, 28 (41.8%) Chinese, 25 (32.5%) Indian migraine patients and five (38.5%) migraine patients from other ethnic groups, had dietary triggers. Some 58 (40.0%) Malay, 27 (25.2%) Chinese, 22 (23.9%) Indian patients and 7 (29.2%) patients from other ethnic groups with TTH had dietary triggers. The most common dietary trigger factors were coffee (19.9%), chocolate (7.5%) and food rich in monosodium glutamate (5.6%). Logistic regression showed that chocolate (OR 2.16, 95% CI 1.06-4.41, p = 0.035) and coffee (OR 1.73, 95% CI 1.12-2.68, p = 0.014) were significantly associated with migraine compared to TTH.
    Conclusion: Chocolate and coffee significantly triggered migraine compared to TTH. Inter-ethnic differences were observed for dietary trigger factors.
    Study site: Neurology clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
    Matched MeSH terms: Migraine Disorders
  9. Shaik MM, Tan HL, Kamal MA, Gan SH
    CNS Neurol Disord Drug Targets, 2014;13(5):828-35.
    PMID: 24040787
    Migraine is a neurovascular disease that has classically been attributed to multifactorial aetiologies, with genetic components and environmental interactions considered the main influence. Genes such as flavoenzyme 5, 10- methylenetetrahydrofolate reductase (MTHFR), especially the C677T variant, have been associated with elevated plasma homocysteine levels. This elevation in homocysteine results in an array of metabolic disorders and increased risk of complex diseases, including migraine. Catalysation of homocysteine requires the presence of vitamins B6, B12 and folate. Deficiencies in these cofactor vitamins result in hypomethylation, which triggers migraine. Because migraine predominantly affects females, it is hypothesised that fluctuating oestrogen levels, which are governed by oestrogen receptor 1 polymorphisms, are important. Another important factor is homocysteine, the production of which is dependent upon MTHFR and B vitamins. Gene expression is modulated through epigenetic mechanisms, which involve methionine. Additionally, folate plays a major role in DNA synthesis. We propose that vitamin B intake, coupled with MTHFR and oestrogen receptor 1 polymorphisms, causes differential DNA methylation and gene expression that may contribute to the occurrence of migraine.
    Matched MeSH terms: Migraine Disorders/etiology; Migraine Disorders/genetics*; Migraine Disorders/metabolism
  10. Chia YC, Lim SH, Wang SJ, Cheong YM, Denaro J, Hettiarachchi J
    Headache, 2003 Oct;43(9):984-90.
    PMID: 14511275
    BACKGROUND/OBJECTIVE: Nonsteroidal anti-inflammatory drugs continue to be one of the most widely used therapies for migraine, but their efficacy in treating moderate to severe migraine headache has not been well documented. In contrast, the efficacy of triptans in this group of patients is well documented, although no systematic research is available that evaluates the effectiveness of switching to a triptan in patients who respond poorly to nonsteroidal anti-inflammatory drugs.

    METHODS: One hundred thirteen patients who met International Headache Society criteria for migraine and who did not experience satisfactory response to nonsteroidal anti-inflammatory drugs, received open-label treatment with a 40-mg dose of eletriptan for one migraine attack. Efficacy assessments were made at 1, 2, 4, and 24 hours postdose and consisted of headache and pain-free response rates, absence of associated symptoms, and functional response. Global ratings of treatment effectiveness and preference were obtained at 24 hours.

    RESULTS: The pain-free response rate at 2 hours postdose was 25% and at 4 hours postdose, 55%; the headache response rate at 2 hours was 66% and at 4 hours, 87%. At 2 hours postdose, relief of baseline associated symptoms was achieved by 41% of patients with nausea compared to 82% of patients at 4 hours; for patients with phonophobia, 67% were relieved at 2 hours and 93% at 4 hours, and for patients with photophobia, 70% were relieved at 2 hours and 91% at 4 hours. Functional response was achieved by 70% of patients by 2 hours postdose. The high level of acute response was maintained over 24 hours, with only 24% of patients experiencing a headache recurrence and only 10% using rescue medication. At 24 hours postdose, 74% of patients rated eletriptan as preferable to any previous treatment for migraine. The most frequent reasons cited for this treatment preference were faster headache improvement (83%) and functional response (78%). Overall, eletriptan was well tolerated; most adverse events were transient and mild to moderate in severity. No serious adverse events were reported.

    CONCLUSION: Results of this open-label trial found the 40-mg dose of eletriptan to have a high degree of efficacy and tolerability among patients who responded poorly to nonsteroidal anti-inflammatory drugs.

    Matched MeSH terms: Migraine Disorders/drug therapy*
  11. Michael NDB, Hussein A, Abd Halim S, Ab Hamid SA
    Cureus, 2019 May 04;11(5):e4599.
    PMID: 31309023 DOI: 10.7759/cureus.4599
    Background Neurovascular changes occur during the migraine is believed to cause alteration in cerebral and retinal circulation that possible result in damage to the brain and even retina or optic nerve. Retinal nerve fiber layer (RNFL) thickness measurement can be used as an index to assess ganglion cell and retinal nerve fiber damages. The aim of this study was to evaluate the optic nerve head (ONH) parameters, RNFL thickness, and ocular perfusion pressure (OPP) in migraine patients. Methods This was a cross-sectional study, conducted in Hospital Universiti Sains Malaysia, Kelantan from July 2016 to November 2018, involving patients with a confirmed diagnosis of migraine and controls. Ninety-four eyes of 47 migraine patients and 94 eyes of 47 healthy subjects were included in this study. Blood pressure and intraocular pressure were measured and OPP was calculated. ONH parameters and RNFL thickness were measured using optical coherence tomography (OCT) after pupillary dilatation. Statistical analysis was done using Statistical Package for the Social Science (SPSS Inc Version 24). Results With respect to all means values of ONH parameters, there was no statistically significant difference between migraine patients and controls. For RNFL, there were significant reductions in average and superior RNFL thickness on both eyes with adjustment of age and gender (P-value: right eye (RE) average = 0.027; RE superior = 0.034; left eye (LE) average = 0.037; LE superior = 0.031). In view of OPP, there was no significant difference between migraine patients and controls (P-value = 0.172). Weak correlations were found between the ONH parameters and RNFL thickness with OPP, respectively, in migraine patients. Conclusion This study showed no difference in ONH parameters between migraine patients and healthy subjects. There was significant thinning in average and superior RNFL for migraine patients. No difference found in OPP between both groups. ONH parameters and RNFL thickness had a weak correlation with OPP in migraine patients.
    Matched MeSH terms: Migraine Disorders
  12. Nor Dalila Marican, Rozita Hod, Nadiah Wan-Arfah, Azmi Hassan
    Int J Public Health Res, 2018;8(1):933-938.
    MyJurnal
    Introduction Non-specific low back pain is one of the most common physical ailments
    affecting millions of people worldwide. This condition constitutes a
    significant public health problem and was listed as a prevalent health
    complaint in most societies. Even though there are many anecdotal claims
    for reflexology in the treatment of various conditions such as a migraine,
    arthritis and multiple sclerosis, but very little clinical evidence exists for
    reflexology on the management of low back pain per se. This study aims to
    evaluate the effects of foot reflexology therapy as an adjunctive treatment to
    the Malaysian low back pain standard care in relieving pain and promoting
    health-related quality of life among people with non-specific low back pain.
    Methods This is a parallel randomized controlled trial with pre and post-treatment
    study design. The study setting for the intervention located at Penawar
    Reflexology Center, Kuala Terengganu, Malaysia. A total of 100
    participants with non-specific low back pain will be allocated to one of two
    groups, using a randomization computer program of Research Randomizer.
    The control group will receive low back pain standard care, while the
    intervention group will receive standard care plus eight sessions of foot
    reflexology therapy. The pain intensity and health-related quality of life
    scores will be measured using Visual Analogue Scale and Euro-quality of
    life scale respectively in both groups. The study was approved by the
    Human Research Ethics Committee of University Sultan Zainal Abidin
    (UHREC/2016/2/011). The study protocol was registered at
    ClinicalTrials.gov, with the ID number of NCT02887430.
    Measurements Outcome measures will be undertaken at pre-intervention (week 1), postintervention
    (week 6) and follow-up (week 10).
    Conclusions This will be the first trial to compare the foot reflexology therapy with
    control group among people who medically diagnosed with non-specific low
    back pain in Malaysia. The result of this study will contribute to better
    management of this population, especially for Malaysia healthcare setting.

    Study site: Penawar Reflexology Center, Kuala Terengganu, Malaysia
    Matched MeSH terms: Migraine Disorders
  13. Sheshala R, Khan N, Darwis Y
    Chem Pharm Bull (Tokyo), 2011;59(8):920-8.
    PMID: 21804234
    The aims of the present research were to mask the intensely bitter taste of sumatriptan succinate and to formulate orally disintegrating tablets (ODTs) of the taste masked drug. Taste masking was performed by coating sumatriptan succinate with Eudragit EPO using spray drying technique. The resultant microspheres were evaluated for thermal analysis, yield, particle size, entrapment efficiency and in vitro taste masking. The tablets were formulated by mixing the taste masked microspheres with different types and concentrations of superdisintegrants and compressed using direct compression method followed by sublimation technique. The prepared tablets were evaluated for weight variation, thickness, hardness, friability, drug content, water content, in vitro disintegration time and in vitro drug release. All the tablet formulations disintegrated in vitro within 37-410 s. The optimized formulation containing 5% Kollidon CL-SF released more than 90% of the drug within 15 min and the release was comparable to that of commercial product (Suminat®). In human volunteers, the optimized formulation was found to have a pleasant taste and mouth feel and disintegrated in the oral cavity within 41 s. The optimized formulation was found to be stable and bioequivalent with Suminat®.
    Matched MeSH terms: Migraine Disorders/drug therapy
  14. Toh, Tsun-Haw, Lim, Kheng-Seang, Ng, Ching-Ching, Imran Idris, Sherrini Bazir Ahmad, Lim, Thien-Thien, et al.
    MyJurnal
    Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary disease of small cerebral arteries. This case series aims to describe the mutations in NOTCH3and their phenotypes in Malaysia. We includedpatients who were genetically confirmed to have CADASIL, diagnosed at the University of Malaya Medical Centre, Malaysia. Family members who fulfilled clinical or imaging criteria, and patients from two previous published Malaysian families were also included. Six families (eleven cases) were included in this series. Genetic testing revealed NOTCH3 mutations in c.328C>T (p.Arg110Cys, R110C), c.553T>G (p.Cys185Gly, C185G), c.1630C>T (p.Arg544Cys, R544C) and c.160C>T (p.Arg54Cys, R54C). Two out of four Chinese families had R544C mutation in exon 11, with a later age of onset, absence of migraine and lack of anterior temporal pole involvement on MRI. One family with mixed Indian and Chinese ancestry had a mutation in exon 3 with R110C and another Indian family exon 4 with C185G mutation. This case series highlights the genotypic and phenotypic variability of CADASIL in a multi-ethniccountry. The finding of p.Arg544Cys mutation among the older Chinese families, similar to those reported in Jeju Island and Taiwan, suggest the need to screen the older Chinese stroke patients with typical MRI changes.
    Matched MeSH terms: Migraine Disorders
  15. Tai MS, Yet SXE, Lim TC, Pow ZY, Goh CB
    Curr Pain Headache Rep, 2019 Feb 21;23(2):12.
    PMID: 30790108 DOI: 10.1007/s11916-019-0760-6
    In this review, we discussed the types and frequencies of trigger factors of primary headache [migraine and tension-type headache (TTH)] among adult patients. We assessed the influence of geographical location, ethnicity and gender on the various trigger factors of a migraine and a TTH. We also evaluated the trigger factors among the multi-ethnic Southeast Asian adult patients. In a recent study, odor triggered more migrainous headaches compared to the other primary headaches. Odor was observed to be specific of migraines. Moreover, stress is one of the most common trigger factors for patients with migraines and TTHs worldwide. Migrainous patients have an increased sensitivity in comparison to non-migrainous patients. Furthermore, these patients have much difficulty in adapting to the high level of sensitivity, and the sensitized brain is therefore more vulnerable to trigger factors. In addition, the presence of one trigger factor may increase the exposure of other trigger factors. This phenomenon is more marked in the patients with migraines who have stress and menstruation as triggers, predisposing them to be more sensitive to other triggers. In conclusion, the geographical location factor has an influence on the trigger factors of headaches. Ethnicity may have an effect due to the cultural differences. Change in weather and sunlight are important commonly identified trigger factors for headaches. Moreover, gender differences in some trigger factors are present among the patients with headaches, especially sunlight and sleep deprivation. More research studies can be conducted to have a better understanding on trigger factors in the future. This will enable proper identification of trigger factors, leading to a decrease in the number of headache episodes and an improvement in quality of life for patients.
    Matched MeSH terms: Migraine Disorders/etiology; Migraine Disorders/epidemiology*
  16. Tan CT
    Family Practitioner, 1982;5(3):61-62.
    A study of 50 healthy nurses from the University Hospital showed that 72% had chronic headache. Among those who had chronic headache, 33% were due to migraine. Another 30% were probable migraine subjects and 33% suffered from tension headache. Twenty two nurses had headache more than once a month and 18 nurses described the headache as moderate to severe. The common precipitating factors mentioned were tension, exposure to the sun, lack of sleep and menstruation.
    Matched MeSH terms: Migraine Disorders
  17. Mohamad Safiai NI, Mohamad NA, Basri H, Inche Mat LN, Hoo FK, Abdul Rashid AM, et al.
    PLoS One, 2021;16(6):e0251528.
    PMID: 34138860 DOI: 10.1371/journal.pone.0251528
    BACKGROUND: Migraine may lead to a negative impact on the patients' quality of life with a subsequent substantial burden to society. Therapy options for treatment and prevention of migraine have progressed over the years and repetitive transcranial magnetic stimulation (rTMS) is one of the promising non-pharmacological options. It induces and alters electric current in the brain via repetitive non-invasive brain stimulation in high frequency. In migraine patients, two common stimulation sites are the M1 cortex and dorsolateral prefrontal cortex (DLPFC). The mechanism on how rTMS exerts therapeutic effects on migraine is not fully established, but the main postulation is that the neuromodulation via high-frequency rTMS (hf-rTMS) might inhibit pain perception. However, evidence from studies has been conflicting, thus the usefulness of hf-rTMS as migraine preventive treatment is still uncertain at this moment.

    METHODS: This is a systematic review protocol describing essential reporting items based on the PRISMA for systematic review protocols (PRISMA-P) (Registration number: CRD42020220636). We aim to review the effectiveness, tolerability, and safety of hf-rTMS at DLPFC in randomised controlled trials (RCTs) as migraine prophylactic treatment. We will search Scopus, Cumulative Index to Nursing and Allied Health Literature Plus, PubMed, Cochrane Central Register of Controlled Trials and Biomed Central for relevant articles from randomised controlled clinical trials that used hf-rTMS applied at DLPFC for the treatment of migraine. The risk of bias will be assessed using the version 2 "Risk of bias" tool from Cochrane Handbook for Systematic Reviews of Interventions Version 6.1. We will investigate the evidence on efficacy, tolerability and safety and we will compare the outcomes between the hf-rTMS intervention and sham groups.

    DISCUSSION: This systematic review will further determine the efficacy, safety, and tolerability of hf-rTMS applied at DLPFC for migraine prophylaxis. It will provide additional data for health practitioners and policymakers about the usefulness of hf-rTMS for migraine preventive treatment.

    Matched MeSH terms: Migraine Disorders/prevention & control*
  18. Islam MA, Kamal MA, Md Zulfiker AH, Gan SH
    Curr Pharm Des, 2019;25(27):2907-2908.
    PMID: 31621552 DOI: 10.2174/138161282527191007151037
    Matched MeSH terms: Migraine Disorders
  19. Wong LP, Alias H, Bhoo-Pathy N, Chung I, Chong YC, Kalra S, et al.
    J Headache Pain, 2020 Jun 08;21(1):68.
    PMID: 32513174 DOI: 10.1186/s10194-020-01144-z
    BACKGROUND/OBJECTIVE: Productivity and monetary loss due to migraine in the workplace may be substantial. This study aimed to determine the impact of migraine on productivity and monetary lost among employees in the banking sectors, in a multiethnic middle income country.

    METHODS: A cross-sectional online survey was conducted among employees in two multinational banks in Malaysia between April and July 2019. Screening for migraine was conducted using the self-administered ID-Migraine™ questionnaire. Migraine-related disability (MIDAS) and headache frequency were recorded. Impact of migraine on work productivity and activities were evaluated using the Work Productivity and Activity Impairment (WPAI) questionnaire.

    RESULTS: Of the 1268 employees who submitted complete responses, 47.2% (n = 598) were screened positive for migraine. Strikingly, the mean percent productivity loss at work (presenteeism) was almost 20-fold higher than the mean percent work time missed due to migraine (absenteeism) (39.1% versus 1.9%). The mean percent productivity loss in regular activity (activity impairment) and overall work productivity loss (work impairment) was 38.4% and 39.9%, respectively. It was also found that the costs related to presenteeism (MYR 5392.6) (US$1296) was 3.5-fold higher than absenteeism (MYR1,548.3) (US$370). Highest monetary loss related to presenteeism was reported in migraineurs with frequency of headache of above 3 days (MYR 25,691.2) (US$6176), whereas highest monetary loss related to absenteeism was reported in migraineurs with MIDAS grade IV (MYR 12,369.1) (US$2973). Only 30% of migraineurs of MIDAS grade IV reported taking prescribed medication. Notably, a vast majority (96%) of migraineurs who had three or lower episodes of migraine per month did not seek treatment.

    CONCLUSION: The significant impact of migraine on work productivity and regular activity, appears to lead to substantial monetary loss attributed to not only absenteeism, but more importantly to presenteeism. This study also highlights the unmet needs in migraine management among employees in the banking sector.

    Matched MeSH terms: Migraine Disorders/economics*; Migraine Disorders/epidemiology*; Migraine Disorders/therapy
  20. Shoji Y, Cohen HV
    MyJurnal
    Migraine is a common disabling primary headache disorder. Ipsilateral radiation of pain to orofacial regions, including teeth, jaws and temporomandibular joints, although not a common complaint, could occur. The area of involvement may obscure the diagnosis and lead to unnecessary dental treatment. A case is presented in which a patient initially sought dental care for left jaw pain that radiated to her left maxillary teeth and temple region and she was also experiencing discomfort in the left masticatory musculature. Subsequently a medical consult diagnosed migraine headache without aura and fortunately unnecessary dental treatment was not done. The key issue here is the complexity of the Trigeminal nerve when the dentist is assessing a patient for dental or other orofacial pain complaints and dental pathology has been ruled out. Equally as important is the dentist taking thorough medical history since a patient may not tell a dentist about a “headache” because the pain is in the teeth and/or jaws. And, perhaps most important is the final differential diagnosis whether made by the dentist or medical care provider.
    Matched MeSH terms: Migraine Disorders
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