Displaying publications 1 - 20 of 37 in total

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  1. Shaik MM, Hassan NB, Tan HL, Bhaskar S, Gan SH
    J Headache Pain, 2015 Mar 14;16:22.
    PMID: 25903056 DOI: 10.1186/s10194-015-0509-5
    BACKGROUND: The Structured Migraine Interview (SMI) is a valid and reliable instrument for migraine diagnosis. However, a Malay version of the SMI is not available to be applied to the local Malaysian population. This study was designed to access the validity and reliability of a new Malay version of the SMI questionnaire.
    METHODS: Patients with headache attending the Neurology Clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia, were screened against the inclusion/exclusion criteria before recruitment. A standard translation procedure was used to translate and adapt the questionnaire into the Malay language. The translated version was tested for face, content and construct validities. Subsequently, validity and reliability studies were conducted (1(st) compilation), followed by retesting seven days later (2(nd) compilation).
    RESULTS: A total of 157 patients between 15 and 60 years of age were enrolled in this study. The kappa value was 0.70 (p 
    Matched MeSH terms: Migraine Disorders/diagnosis*
  2. 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
  3. Tan HJ, Suganthi C, Dhachayani S, Rizal AM, Raymond AA
    Med J Malaysia, 2007 Mar;62(1):56-8.
    PMID: 17682573 MyJurnal
    Migraine is associated with a variety of electroencephalographic (EEG) changes. Previous studies using analogue EEG and old diagnostic criteria may under or over report the prevalence of EEG changes in migraine. The objective of this study was to reevaluate the EEG changes in migraine patients diagnosed by applying the new International Classification of Headache Disorder -2 criteria. This was a case control study involving 70 migraine patients and 70 age and gender matched control who were subjected to scalp EEG. The EEG changes during hyperventilation (HV), which were significantly more common in the migraine group were theta activity (34 vs 22, p = 0.038) and frontal intermittent rhythmic delta activity (FIRDA) (10 vs 3, p = 0.042). Applying the new ICHD -2 diagnostic criteria and digital EEG, this study yielded previously unrecognized features including FIRDA during HV on EEG.
    Matched MeSH terms: Migraine Disorders/classification; Migraine Disorders/diagnosis*
  4. Kam CS
    Med J Malaysia, 1980 Mar;34(3):221-5.
    PMID: 7412662
    This is a report of migraine from Malaysia. 17 migraineurs are studied with respect to age, sex, ethnic group, occupation, age of onset, length of disease,' precipitating factors, relieving factors and family history. Similarities and differences between Malaysians and Caucasians are discussed.
    Study site: Neurology clinic, Hospital Kuala Lumpur, Malaysia
    Matched MeSH terms: Migraine Disorders/etiology*
  5. 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*
  6. Tan HJ, Suganthi C, Dhachayani S, Rizal AM, Raymond AA
    Singapore Med J, 2007 Apr;48(4):307-10.
    PMID: 17384877
    Migraine is associated with a variety of personality traits. The objective of this study was to reevaluate the personality traits using Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in migraine patients diagnosed by applying the new International Classification of Headache Disorders-2 criteria.
    Matched MeSH terms: Migraine Disorders/psychology*
  7. Loo CY, Tan HJ, Teh HS, Raymond AA
    Singapore Med J, 2007 Sep;48(9):834-9.
    PMID: 17728965
    INTRODUCTION: Migraine is a common disabling condition that results in considerable socioeconomic loss. The role of non-steroidal anti-inflammatory drugs (NSAIDs) in acute migraine has been well-established. We compared the efficacy of the cyclooxygenase-2 inhibitor celecoxib with the NSAID, naproxen sodium, in the treatment of acute migraine.
    METHODS: This was a randomised, open label, controlled trial. We selected patients with a diagnosis of migraine, based on the International Headache Society revised criteria. 60 patients were randomised to either celecoxib 400 mg (30 patients) or naproxen sodium 550 mg (30 patients). Patients took the study medicine for the first acute migraine episode that occurred during the study period and reported the headache reduction based on a visual analogue score (VAS). Patients were reviewed after a month to check on VAS at one and two hours, compared to the baseline. Any side effects of the medication were also recorded.
    RESULTS: Of the 52 patients who completed the study, eight did not experience any headaches. The mean VAS in the celecoxib group improved significantly from baseline (6.48 +/- 1.53) to one hour (4.28 +/- 2.11) and two hours (2.24 +/- 2.57) (p-value is less than 0.0005). The mean VAS in the naproxen sodium group also improved significantly from baseline (7.30 +/- 1.66) to one hour (4.81 +/- 2.50) and two hours (2.63 +/- 2.65) (p-value is less than 0.0005). However, there was no significant difference between the magnitudes of improvement between the treatment groups. The incidence of gastric pain was significantly higher in the naproxen sodium group (p-value is equal to 0.029).
    CONCLUSION: In comparison with naproxen sodium, celecoxib was equally effective in relieving pain in acute migraine and caused significantly less gastric pain.

    Study site: neurology outpatient clinic in Pusat Perubatan
    Universiti Kebangsaan Malaysia (PPUKM)
    Matched MeSH terms: Migraine Disorders/drug therapy*
  8. 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*
  9. 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*
  10. Choudhary AK, Lee YY
    Nutr Neurosci, 2018 Jun;21(5):306-316.
    PMID: 28198207 DOI: 10.1080/1028415X.2017.1288340
    Aspartame (α-aspartyl-l-phenylalanine-o-methyl ester), an artificial sweetener, has been linked to behavioral and cognitive problems. Possible neurophysiological symptoms include learning problems, headache, seizure, migraines, irritable moods, anxiety, depression, and insomnia. The consumption of aspartame, unlike dietary protein, can elevate the levels of phenylalanine and aspartic acid in the brain. These compounds can inhibit the synthesis and release of neurotransmitters, dopamine, norepinephrine, and serotonin, which are known regulators of neurophysiological activity. Aspartame acts as a chemical stressor by elevating plasma cortisol levels and causing the production of excess free radicals. High cortisol levels and excess free radicals may increase the brains vulnerability to oxidative stress which may have adverse effects on neurobehavioral health. We reviewed studies linking neurophysiological symptoms to aspartame usage and conclude that aspartame may be responsible for adverse neurobehavioral health outcomes. Aspartame consumption needs to be approached with caution due to the possible effects on neurobehavioral health. Whether aspartame and its metabolites are safe for general consumption is still debatable due to a lack of consistent data. More research evaluating the neurobehavioral effects of aspartame are required.
    Matched MeSH terms: Migraine Disorders/chemically induced; Migraine Disorders/diagnosis
  11. Tzeng HR, Lee MT, Fan PC, Knutson DE, Lai TH, Sieghart W, et al.
    Neurotherapeutics, 2021 Jan;18(1):569-585.
    PMID: 33111258 DOI: 10.1007/s13311-020-00951-1
    Migraine is caused by hyperactivity of the trigeminovascular system, where trigeminal ganglia (TG) play an important role. This hyperactivity might originate from an underfunctional GABAergic system in TG. To investigate this possibility, we adapted a mouse model of migraine by inducing migraine-like grimaces in male mice via repeated injections of nitroglycerin (NTG, 10 mg/kg, i.p.), once every 2 days, for up to 5 sessions. Migraine-like facial pain scores were measured using the mouse grimace scale. Repeated NTG treatments in mice caused significant increases in migraine-like grimaces that were aborted and prevented by two anti-migraine agents sumatriptan and topiramate, respectively. After 5 sessions of NTG injections, the GABA-synthesizing enzyme, 65-kDa glutamate decarboxylase (GAD65), but not the GABA transporter 1 (GAT1) or the α6 subunit-containing GABAA receptors (α6GABAARs), was downregulated in mouse TG tissues. Taking advantage of the unaffected TG α6GABAAR expression in NTG-treated mice, we demonstrated that an α6GABAAR-selective positive allosteric modulator (PAM), DK-I-56-1, exhibited both abortive and prophylactic effects, comparable to those of sumatriptan and topiramate, respectively, in this migraine-mimicking mouse model. The brain-impermeable furosemide significantly prevented the effects of DK-I-56-1, suggesting its peripheral site of action, likely via preventing α6GABAAR modulation in TG. Results suggest that a decreased GABA synthesis caused by the reduced GAD65 expression in TG contributes to the trigeminovascular activation in this repeated NTG-induced migraine-mimicking model and that the unaltered α6GABAARs in TG are potential targets for migraine treatment. Thus, α6GABAAR-selective PAMs are potential anti-migraine agents for both abortive and preventive therapies.
    Matched MeSH terms: Migraine Disorders/chemically induced; Migraine Disorders/drug therapy*
  12. Bhaskar S, Abdullah JM
    Neurosciences (Riyadh), 2013 Apr;18(2):185-6.
    PMID: 23545624
    Matched MeSH terms: Migraine Disorders; Migraine Disorders/genetics*
  13. 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*
  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. Juliena Muhammed, Sanihah Abdul Halim, Wan Hazabbah Wan Hitam, Tharakan, John
    Neurology Asia, 2014;19(3):323-326.
    MyJurnal
    Migraine with aura is one of the major subtypes of migraine, and can be associated with ischaemic brain infarction. Use of oral contraceptive pills (OCPs) increases the risk of infarction in this type of migraine. Seizures and migraine also have a complex relationship, one element of which is migraine- triggered seizures. We report a case of bilateral occipital lobe infarction and migraine-triggered seizures, most likely precipitated by oral contraceptive pills (OCPs) in a patient with migraine with visual aura. OCPs, triptans and ergotamines should be used cautiously in these patients. Methods of birth control other than OCPs should be considered.
    Matched MeSH terms: Migraine Disorders
  16. 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
  17. Tan, Ciang Sang, Haiza Hani Hamidon, Zainah Shaikh Hedra
    MyJurnal
    Background: A 9 year old boy presented with history of persistent headache and recurrent vomiting for 1 month post dental extraction. CT brain was performed for the possibility of space occupying lesion but it was normal. Subsequently, he was treated as migraine after exclusion of meningitis and intracranial lesion. Unfortunately, he developed 3rd, 4th and 6th cranial nerve palsy two weeks later. Repeated CT brain showed subtle finding and inconclusive. MRI brain performed at the time showed features suggestive of basal skull osteomyelitis with congestion of right orbit and optic nerve swelling. Case was referred to Paediatric Neurologist and he was diagnosed to have cranial nerve palsy secondary to basal skull osteomyelitis, post dental extraction.

    Conclusion: Dental procedure is common among children, however basal skull osteomyelitis with cranial nerve palsy is a rare complication. Adequate treatment of dental infection post dental procedure is important to prevent this complication.
    Matched MeSH terms: Migraine Disorders
  18. 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
  19. Teo WP, Kannan A, Loh PK, Chew E, Sharma VK, Chan YC
    J Clin Diagn Res, 2014 Sep;8(9):MM01-2.
    PMID: 25386478 DOI: 10.7860/JCDR/2014/9377.4886
    BACKGROUND: Two small studies had evaluated the efficacy of rTMS in migraine. One tested high frequency rTMS over the dorsolateral prefrontal cortex while the other evaluated 1 Hz rTMS over the vertex.
    AIM: To test the feasibility of 10 Hz rTMS of motor cortex as an adjunctive therapy in patients with chronic migraine
    Materials and Methods: We randomized (2:1 ratio) chronic migraine patients on medical preventive treatment to receive either rTMS or sham therapy for 10 sessions. rTMS (80% resting motor threshold, 10Hz, 20 trains, 5 secs/train, inter-train interval 1 min, total 1000 stimuli/session) was applied over the right motor cortex.
    RESULT: Nine patients were randomized. Six received rTMS and three had sham therapy. Three patients in the rTMS arm withdrew from the study due to increased headache frequency and discomfort from the treatment. The remaining six cases (3 rTMS, 3 sham) completed the study. The study was prematurely stopped due to the significant worsening of headache from rTMS. No significant differences in outcome measures were found between real and sham rTMS.
    CONCLUSION: Although the study was terminated prematurely, the high dropout rate (50%) due to worsening headaches suggested that rTMS over the motor cortex is poorly tolerated in chronic migraine.
    KEYWORDS: Adverse effect; Central sensitization; Chronic migraine; Cortical excitability; Headache; rTMS
    Study site: Neuroscience clinic of National University Hospital, Singapore
    Matched MeSH terms: Migraine Disorders*
  20. Sathasivam S, Sathasivam S
    J Cardiol, 2013 Apr;61(4):256-9.
    PMID: 23484805 DOI: 10.1016/j.jjcc.2012.12.005
    There is conflicting evidence on the causal relationship of patent foramen ovale (PFO) in migraine. This review will examine the pathophysiological relevance of PFO in migraine, the epidemiological evidence of PFO causing migraine, and the existing evidence on the effectiveness of closure of PFO on the symptomatology of migraine. From the current available evidence, the role of PFO in migraine is debatable, and interventions such as closure of PFO cannot yet be considered routine treatment of migraine.
    Matched MeSH terms: Migraine Disorders/etiology*; Migraine Disorders/therapy
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