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Migraine Disorders: HELP
Articles by Arne May
Based on 44 articles published since 2008
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Between 2008 and 2019, A. May wrote the following 44 articles about Migraine Disorders.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline [Consensus paper of the German Migraine and Headache Society on the structure of headache care facilities in Germany]. 2014

Marziniak, M / Malzacher, V / Förderreuther, S / Jürgens, T / Kropp, P / May, A / Straube, A / Anonymous6330790. ·Neurologische Klinik, Isar-Amper-Klinikum München-Ost, Haar, Deutschland. ·Schmerz · Pubmed #24718744.

ABSTRACT: This consensus paper introduces a classification of headache care facilities on behalf of the German Migraine and Headache Society. This classification is based on the recommendations of the International Association for the Study of Pain (IASP) and the European Headache Federation (EHF) and was adapted to reflect the specific situation of headache care in Germany. It defines three levels of headache care: headache practitioner (level 1), headache outpatient clinic (level 2) and headache centers (level 3). The objective of the publication is to define and establish reliable criteria in the field of headache care in Germany.

2 Guideline Self-medication of migraine and tension-type headache: summary of the evidence-based recommendations of the Deutsche Migräne und Kopfschmerzgesellschaft (DMKG), the Deutsche Gesellschaft für Neurologie (DGN), the Österreichische Kopfschmerzgesellschaft (ÖKSG) and the Schweizerische Kopfwehgesellschaft (SKG). 2011

Haag, Gunther / Diener, Hans-Christoph / May, Arne / Meyer, Christian / Morck, Hartmut / Straube, Andreas / Wessely, Peter / Evers, Stefan / Anonymous2880682 / Anonymous2890682 / Anonymous2900682 / Anonymous2910682. ·Michael-Balint-Klinik, Königsfeld, Germany. guntherhaag@hotmail.com ·J Headache Pain · Pubmed #21181425.

ABSTRACT: The current evidence-based guideline on self-medication in migraine and tension-type headache of the German, Austrian and Swiss headache societies and the German Society of Neurology is addressed to physicians engaged in primary care as well as pharmacists and patients. The guideline is especially concerned with the description of the methodology used, the selection process of the literature used and which evidence the recommendations are based upon. The following recommendations about self-medication in migraine attacks can be made: The efficacy of the fixed-dose combination of acetaminophen, acetylsalicylic acid and caffeine and the monotherapies with ibuprofen or naratriptan or acetaminophen or phenazone are scientifically proven and recommended as first-line therapy. None of the substances used in self-medication in migraine prophylaxis can be seen as effective. Concerning the self-medication in tension-type headache, the following therapies can be recommended as first-line therapy: the fixed-dose combination of acetaminophen, acetylsalicylic acid and caffeine as well as the fixed combination of acetaminophen and caffeine as well as the monotherapies with ibuprofen or acetylsalicylic acid or diclofenac. The four scientific societies hope that this guideline will help to improve the treatment of headaches which largely is initiated by the patients themselves without any consultation with their physicians.

3 Guideline EFNS guideline on the drug treatment of migraine--revised report of an EFNS task force. 2009

Evers, S / Afra, J / Frese, A / Goadsby, P J / Linde, M / May, A / Sándor, P S / Anonymous120637. ·Department of Neurology, University of Münster, Münster, Germany. everss@uni-muenster.de ·Eur J Neurol · Pubmed #19708964.

ABSTRACT: BACKGROUND: Migraine is one of the most frequent disabling neurological conditions with a major impact on the patients' quality of life. OBJECTIVES: To give evidence-based or expert recommendations for the different drug treatment procedures in the particular migraine syndromes based on a literature search and the consensus of an expert panel. METHODS: All available medical reference systems were screened for the range of clinical studies on migraine with and without aura and on migraine-like syndromes. The findings in these studies were evaluated according to the recommendations of the European Federation of Neurological Societies (EFNS) resulting in level A, B, or C recommendations and good practice points. RECOMMENDATIONS: For the acute treatment of migraine attacks, oral non-steroidal antiinflammatory drug (NSAID) and triptans are recommended. The administration should follow the concept of stratified treatment. Before intake of NSAID and triptans, oral metoclopramide or domperidone is recommended. In very severe attacks, intravenous acetylsalicylic acid or subcutaneous sumatriptan are drugs of first choice. Status migrainosus can be treated by cortoicosteroids, although this is not universally held to be helpful, or dihydroergotamine. For the prophylaxis of migraine, betablockers (propranolol and metoprolol) flunarizine, valproic acid, and topiramate are drugs of first choice. Drugs of second choice for migraine prophylaxis include amitriptyline, naproxen, petasites, and bisoprolol.

4 Editorial Pearls and Pitfalls in Migraine Neuroimaging. 2017

Schulte, Laura / May, Arne. ·Department of Systems Neuroscience and Headache Outpatient Department, University Medical Center Eppendorf, Hamburg, Germany. ·Headache · Pubmed #28594126.

ABSTRACT: -- No abstract --

5 Editorial Letter from the Editor-in-Chief. 2016

May, Arne. ·Department of Systems Neuroscience, Institute for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Germany a.may@uke.uni-hamburg.de. ·Cephalalgia · Pubmed #26681791.

ABSTRACT: -- No abstract --

6 Review Understanding migraine as a cycling brain syndrome: reviewing the evidence from functional imaging. 2017

May, Arne. ·Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. a.may@uke.de. ·Neurol Sci · Pubmed #28527054.

ABSTRACT: Due to the clinical picture and also based on early imaging data (Weiller et al. Nat Med 1:658-660, 1995), the brainstem and midbrain structures have been intensely discussed as possible driving or generating structures in migraine. The fact that the brainstem activation persisted after treatment makes it unlikely that this activation was only due to increased activity of the endogenous anti-nociceptive system. It was consequently (and somewhat simplifying) coined the "migraine generator". Since then several studies have focussed on this region when investigating episodic, but also chronic migraine. Denuelle et al. were the first to not only demonstrate significant activations in the midbrain and pons but also in the hypothalamus, which, just like the brainstem activation in the first study, persisted after headache relief with sumatriptan. Expanding these studies into f-MRI studies, refined the involvement of rostral parts of the pons in acute migraine attacks. However, they also focused on the preictal stage of NO-triggered and native human migraine attacks and suggested a predominant role of the hypothalamus shortly before the beginning of migraine headaches as well as alterations in hypothalamic functional connectivity. Additionally, changes in resting-state functional connectivity of the dorsal pons and the hypothalamus in interictal migraineurs has recently been found. The pathophysiology and genesis of migraine attacks is probably not just the result of one single "brainstem generator". Spontaneous oscillations of complex networks involving the hypothalamus, brainstem, and dopaminergic networks lead to changes in activity in certain subcortical and brainstem areas, thus changing susceptibility thresholds and not only starting but also terminating headache attacks.

7 Review Of generators, networks and migraine attacks. 2017

Schulte, Laura H / May, Arne. ·Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. ·Curr Opin Neurol · Pubmed #28240611.

ABSTRACT: PURPOSE OF REVIEW: One of the most discussed topics in migraine pathophysiology is where migraine attacks originate. Although recent evidence suggests central attack generating loci, there is an ongoing debate about the involved centres of the brain and brainstem. RECENT FINDINGS: Recent neuroimaging studies focussing on the preictal stage of migraine attacks suggest a predominant role of the hypothalamus and its functional connectivity shortly before the beginning of migraine headaches. In interictal migraineurs, changes in resting state functional connectivity of the dorsal pons and the hypothalamus have been found. SUMMARY: Based on the clinical presentation of the premonitory phase of migraine, the hypothalamus and changes within the dopaminergic system have been discussed as likely candidates for attack generation. Neuroimaging studies however suggested the dorsal pons as attack generator. Taking into account the recent findings of hypothalamic involvement and changing connectivity in the preictal stage, the available evidence suggests that the idea of a single migraine generator within the human brain is probably too simplistic. More likely, spontaneous oscillations of complex networks lead to activity changes in certain subcortical and brainstem areas. This in turn might constitute functional changes of descending pain-modulating pathways, and thus the generation of migraine pain.

8 Review Chronic migraine: risk factors, mechanisms and treatment. 2016

May, Arne / Schulte, Laura H. ·Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany. ·Nat Rev Neurol · Pubmed #27389092.

ABSTRACT: Chronic migraine has a great detrimental influence on a patient's life, with a severe impact on socioeconomic functioning and quality of life. Chronic migraine affects 1-2% of the general population, and about 8% of patients with migraine; it usually develops from episodic migraine at an annual conversion rate of about 3%. The chronification is reversible: about 26% of patients with chronic migraine go into remission within 2 years of chronification. The most important modifiable risk factors for chronic migraine include overuse of acute migraine medication, ineffective acute treatment, obesity, depression and stressful life events. Moreover, age, female sex and low educational status increase the risk of chronic migraine. The pathophysiology of migraine chronification can be understood as a threshold problem: certain predisposing factors, combined with frequent headache pain, lower the threshold of migraine attacks, thereby increasing the risk of chronic migraine. Treatment options include oral medications, nerve blockade with local anaesthetics or corticoids, and neuromodulation. Well-defined diagnostic criteria are crucial for the identification of chronic migraine. The International Headache Society classification of chronic migraine was recently updated, and now allows co-diagnosis of chronic migraine and medication overuse headache. This Review provides an up-to-date overview of the classification of chronic migraine, basic mechanisms and risk factors of migraine chronification, and the currently established treatment options.

9 Review Efficacy of interventions used by physiotherapists for patients with headache and migraine-systematic review and meta-analysis. 2016

Luedtke, Kerstin / Allers, Angie / Schulte, Laura H / May, Arne. ·Department of Systems Neuroscience, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Germany. · Department of Systems Neuroscience, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Germany a.may@uke.de. ·Cephalalgia · Pubmed #26229071.

ABSTRACT: AIM: We aimed to conduct a systematic review evaluating the effectiveness of interventions used by physiotherapists on the intensity, frequency and duration of migraine, tension-type (TTH) and cervicogenic headache (CGH). METHODS: We performed a systematic search of electronic databases and a hand search for controlled trials. A risk of bias analysis was conducted using the Cochrane risk of bias tool (RoB). Meta-analyses present the combined mean effects; sensitivity analyses evaluate the influence of methodological quality. RESULTS: Of 77 eligible trials, 26 were included in the RoB assessment. Twenty trials were included in meta-analyses. Nineteen out of 26 trials had a high RoB in >1 domain. Meta-analyses of all trials indicated a reduction of TTH ( ITALIC! p < 0.0001; mean reduction -1.11 on a 0-10 visual analog scale (VAS); 95% CI -1.64 to -0.57) and CGH ( ITALIC! p = 0.0002; mean reduction -2.52 on a 0-10 VAS; 95% CI -3.86 to -1.19) pain intensity, CGH frequency ( ITALIC! p < 0.00001; mean reduction -1.34 days per month; 95% CI -1.40 to -1.28), and migraine ( ITALIC! p = 0.0001; mean reduction -22.39 hours without relief; 95% CI -33.90 to -10.88) and CGH ( ITALIC! p < 0.00001; mean reduction -1.68 hours per day; 95% CI -2.09 to -1.26) duration. Excluding high RoB trials increased the effect sizes and reached additional statistical significance for migraine pain intensity ( ITALIC! p < 0.00001; mean reduction -1.94 on a 0-10 VAS; 95% CI -2.61 to -1.27) and frequency ( ITALIC! p < 0.00001; mean reduction -9.07 days per month; 95% CI -9.52 to -8.62). DISCUSSION: Results suggest a statistically significant reduction in the intensity, frequency and duration of migraine, TTH and CGH. Pain reduction and reduction in CGH frequency do not reach clinically relevant effect sizes. Small sample sizes, inadequate use of headache classification, and other methodological shortcomings reduce the confidence in these results. Methodologically sound, randomized controlled trials with adequate sample sizes are required to provide information on whether and which physiotherapy approach is effective. According to Grading of Recommendations Assessment, Development and Evaluation (GRADE), the current level of evidence is low.

10 Review Headache research in 2014: Advancing migraine therapy. 2015

Schulte, Laura H / May, Arne. ·Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg D-22046, Germany. · Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg D-22046, Germany. Electronic address: a.may@uke.de. ·Lancet Neurol · Pubmed #25496881.

ABSTRACT: -- No abstract --

11 Review [Update on trigeminal autonomic cephalalgia]. 2013

Gaul, C / Holle, D / May, A. ·Migräne- und Kopfschmerzklinik Königstein, Ölmühlweg 31, 61462, Königstein im Taunus, Deutschland, c.gaul@migraene-klinik.de. ·Nervenarzt · Pubmed #24212418.

ABSTRACT: Cluster headache, paroxysmal hemicrania and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome) are classified under trigeminal autonomic cephalalgia (TAC). The proposed revision of the international classification of headache disorders (ICDH-3 beta) adds hemicrania continua to this diagnostic group. Moreover, diagnostic criteria of the other TACs were modified and are characterized by persistent headache or headache attacks accompanied by cranial autonomic symptoms. The main difference between the various TACs is the duration of attacks. Differentiation is important because different pharmacological strategies are necessary.

12 Review Pearls and pitfalls: neuroimaging in headache. 2013

May, Arne. ·Department of Systems Neuroscience, University of Hamburg, Germany. a.may@uke.uni-hamburg.de ·Cephalalgia · Pubmed #23671252.

ABSTRACT: PREMISE: One of the most exciting developments in modern neuroscience was the development of imaging techniques providing a non-invasive technique for detection of structure-function relationships characteristic of pain and headache. There is no question that neuroimaging has provided us with a better understanding of how the aura in migraine develops, and it has served as a bridge between neurophysiological studies and clinical findings, although doubtless several questions remain. PEARLS: Neuroimaging drew attention toward central mechanisms in idiopathic headache syndromes. Outstanding functional studies have reinforced the crucial role of the brainstem in acute and chronic migraine and the hypothalamic area in trigemino-autonomic headaches. Several morphometric studies suggest a decreased gray matter in pain-transmitting areas in headache patients; however, those have to be seen in the light of a wealth of pain studies and studies on exercise-dependent plasticity. GOAL: This review focuses on neuroimaging as a scientific tool and highlights the recent advances made in studying primary headache syndromes using functional and structural neuroimaging techniques. It will also point toward open questions and gives recommendations for future studies.

13 Review Does the neurobiology of migraine make migraine patients "difficult"? 2012

Jürgens, Tim P / May, Arne. ·Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. ·Headache · Pubmed #23016885.

ABSTRACT: -- No abstract --

14 Review [Diagnosis and therapy of chronic headaches]. 2010

May, A / Jürgens, T P. ·Institut für Systemische Neurowissenschaften, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Deutschland. a.may@uke.uni-hamburg.de ·Nervenarzt · Pubmed #20464540.

ABSTRACT: Chronic headaches are defined as headaches occurring more than 15 days per month for several months. In clinical practice, chronic migraine, chronic tension-type headache, hemicrania continua and new daily persistent headache are the most important ones. The differential diagnosis is usually a challenge, as it can be difficult to distinguish symptomatic variants from primary headaches. Medication overuse headache is an important differential diagnosis. Epidemiological studies show that primary forms are predominantly rare with a prevalence of less than 1%. Regarding diagnostic investigations, cerebral MRI scans are the method of choice followed by lumbar puncture. The therapeutic management has to be tailor made. Hemicrania continua is exceptional with its obligatory response to indomethacin, a fact that is crucial for the diagnosis and simultaneously represents the treatment of choice. The group of symptomatic headaches is heterogeneous. Red flags help to judge the necessity of further diagnostic tests.

15 Review [The window into headache research : what have we learned from functional and structural neuroimaging]. 2010

May, A. ·Institut für systemische Neurowissenschaften, Universitäts-Krankenhaus Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland. a.may@uke.uni-hamburg.de ·Schmerz · Pubmed #20376601.

ABSTRACT: Current functional neuroimaging studies in headache patients have demonstrated that changes in vascular function are not the primary cause for the pain in migraine. Especially in headache research, functional imaging revealed for the first time important information on the pathophysiology of idiopathic syndromes beyond mere anatomical attribution. Several independent studies have reinforced the crucial role of the brainstem in migraine resulting in primary dysfunction of the endogenous antinociceptive systems, including the periaqueductal grey and the dorsal raphe nucleus (DRN) in the midbrain as well as areas involved in the neuronal regulation of cerebral blood flow (DRN and locus coeruleus). The hypothalamus on the other hand is involved in the fundamental processes leading to the acute attacks of cluster headache. These data have been repeatedly replicated by several groups and led to a new understanding of the pathophysiology of these syndromes and specifically the central role of the brain. The recent studies investigating the structural changes in migraine, chronic tension-type headache and cluster headache are not yet clear in their relevance but raise important questions and promise increasing knowledge of one of the most frequent symptoms in humans.

16 Review Morphing voxels: the hype around structural imaging of headache patients. 2009

May, Arne. ·Department of Systems Neuroscience, Universitäts-Krankenhaus Eppendorf , Martinistrasse 52, Hamburg, Germany. a.may@uke.uni-hamburg.de ·Brain · Pubmed #19443629.

ABSTRACT: Neuroimaging analysis using structural data has begun to provide insights into the pathophysiology of headache syndromes. Several independent studies have suggested a decrease in grey matter in pain-transmitting areas in migraine patients. Most of these data are discussed as damage or loss of brain grey matter, reinforcing the idea of migraine as a progressive disease. However, given what we know about the nature of morphometric changes detectable by the methods we have to date, this interpretation is highly speculative and not supported by the data. It is likely that these changes are the consequence and not the cause of the respective headache syndromes, as they are probably not irreversible and only mirror the proportion or duration of pain suffered. Moreover, structural changes are not headache specific and have to be seen in the light of a wealth of pain studies using these methods. The studies in cluster headache patients prompted the use of stereotactic stimulation of the hypothalamic target point identified by functional and structural neuroimaging. Due to the nature of the methods used and due to a high anatomical variance it is more than questionable to use this point as a definite answer to the source of the headache in clusters and even more so when it is uncritically used in individuals. We need a way to study each patient individually using the functional imaging method with the highest spatial and temporal resolution available to enable us to target the seed point for deep brain stimulation on this individual basis. One of the major future challenges is to understand the behavioural consequences and cellular mechanisms underlying neuroanatomic changes in pain and headache.

17 Review The phenomenon of changes in cortical excitability in migraine is not migraine-specific--a unifying thesis. 2009

Stankewitz, Anne / May, Arne. ·Department of Systems Neuroscience, University of Hamburg, UKE, Martinistrasse 52, D-20246 Hamburg, Germany. a.may@uke.uni-hamburg.de ·Pain · Pubmed #19359096.

ABSTRACT: -- No abstract --

18 Review [Therapy of primary chronic headache: chronic migraine, chronic tension type headache and other forms of daily chronic headache]. 2008

Straube, A / May, A / Kropp, P / Katsarava, Z / Haag, G / Lampl, C / Sándor, P S / Diener, H-C / Evers, S. ·Neurologische Klinik, Klinikum Grosshadern der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 München, Deutschland. astraube@nefo.med.uni-muenchen.de ·Schmerz · Pubmed #18483751.

ABSTRACT: The criteria of the International Headache Society (IHS) define four different primary headache syndromes with daily chronic headaches: chronic migraine, episodic and chronic tension type headache, hemicrania continua, new daily persisting headache. A further important differential diagnosis is medication overuse headache (previously known as analgesia headache). The German, Austrian, and Swiss headache societies now present the first joint guidelines for therapy of these headache syndromes. The current literature was reviewed and a summary is presented. The therapy recommendations do not only include the scientific evidence but also the practical relevance.

19 Review [Cortical dysbalance in the brain in migraineurs--hyperexcitability as the result of sensitisation?]. 2008

Stankewitz, A / May, A. ·Institut für systemische Neurowissenschaften, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. ·Schmerz · Pubmed #18228046.

ABSTRACT: A cortical dysbalance has a pivotal role in the pathophysiology of migraine. Numerous electrophysiological and transcranial magnetic stimulation (TMS) studies have investigated the interictal excitability level in migraineurs and have shown a consistent lack of habituation during repetitive stimulation. There is some controversy in the current literature over whether this deficit is based on a lowered or an elevated preactivation level. However, the current discussion may be misguided. It seems that multiple external and intrinsic factors influence the level of cortical excitability and the frequency and intensity of attacks: Habituation is specific neither to migraine nor even to pain; the same phenomenon is found in tinnitus patients, for example. Cortical hyperexcitability is presumably the result of chronicity and the concomitant central sensitisation process.

20 Clinical Trial Neuronal mechanisms during repetitive trigemino-nociceptive stimulation in migraine patients. 2010

Aderjan, David / Stankewitz, Anne / May, Arne. ·Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Germany. ·Pain · Pubmed #20638178.

ABSTRACT: Habituation deficits in various sensory modalities have been observed in migraine patients in several experimental designs. The underlying neuronal mechanisms are, however, still unknown. Past studies have used electrophysiological measures and focussed on habituation behaviour during one single session. We were interested in how repeated painful stimulation over several days is processed, perceived and modulated in migraineurs. Fifteen migraine patients and 15 healthy controls were stimulated daily with a 20 min trigeminal pain paradigm for eight consecutive days, using functional MRI performed on days one and eight and one follow-up measurement three months later. The results demonstrate that migraine patients did not differ in behavioural pain ratings compared to the controls at any time. However, functional imaging data revealed a significant difference in several brain areas over time. The activity level in the prefrontal cortex (PFC) and the rostral anterior cingulate cortex (rACC) increased in healthy control subjects from day one to day eight, whereas it decreased in migraine patients. These data suggest that several brain areas known to be involved in endogenous pain control show a completely opposite behaviour in migraine patients compared to healthy controls. These brain networks seem not to be disrupted per se in migraine patients but changed activity over time responding to repetitive nociceptive input. The alteration of pain inhibitory circuits may be the underlying mechanism responsible for the dys-functional neuronal filters of sensory input.

21 Article Quantitative sensory testing in migraine patients must be phase-specific. 2018

Peng, Kuan-Po / May, Arne. ·Department of Systems Neuroscience, University Medical Center Hamburg Eppendorf, Hamburg, Germany. ·Pain · Pubmed #30335724.

ABSTRACT: -- No abstract --

22 Article Altered muscle activity during rest and during mental or physical activity is not a trait symptom of migraine - a neck muscle EMG study. 2018

Luedtke, Kerstin / Mehnert, Jan / May, Arne. ·Department of Systems Neuroscience, University Medical Center Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. · Department of Academic Physiotherapy, University of Luebeck, Luebeck, Germany. · Department of Systems Neuroscience, University Medical Center Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. a.may@uke.de. ·J Headache Pain · Pubmed #29556874.

ABSTRACT: BACKGROUND: Migraineurs have a high prevalence of neck pain prior to or during headache attacks. Whether neck pain is a symptom of migraine or an indicator for a constant neck muscle dysfunction potentially triggering migraine attacks is a topic of scientific debate. The presence of myofascial trigger points in neck muscles including the trapezius muscle, points towards muscle alterations associated with migraine. We measured electromyography (EMG) of the neck muscles in a large cohort to identify whether neck pain and neckmuscle tension reported by migraine patients can be attributed to increased neck muscle activation during rest, mental stress or physical activity. METHODS: Surface EMG responses of the trapezius muscle were recorded during a paradigm including rest periods, mental stress and physical activity of 102 participants (31 chronic migraine, 43 episodic migraine, 28 healthy participants). RESULTS: All groups showed increased trapezius activity during mental stress and physical activity compared to rest. There was no statistically significant difference between migraine patients and healthy controls for any of the 3 conditions except for the initial mental stress situation (F (2,56.022) = 8.302, p = 0.001), where controls increased tension by only 4.75%, episodic migraineurs by 17.39% and chronic migraineurs by 28.61%. Both migraine groups returned to resting EMG levels within the same timeframe as healthy controls. CONCLUSIONS: Neck pain associated with migraine can therefore not be attributed to increased trapezius activity during rest, mental stress and physical activity or prolonged muscle activity and should not be seen as a constantly underlying trigger but rather as an accompanying symptom of migraine.

23 Article Musculoskeletal dysfunction in migraine patients. 2018

Luedtke, Kerstin / Starke, Wiebke / May, Arne. ·Department of Systems Neuroscience, University Hospital Hamburg-Eppendorf, Hamburg, Germany. ·Cephalalgia · Pubmed #28641450.

ABSTRACT: Objective The aim of this project was to evaluate the prevalence and pattern of musculoskeletal dysfunctions in migraine patients using a rigorous methodological approach and validating an international consensus cluster of headache assessment tests. Methods A physiotherapist, blinded towards the diagnosis, examined 138 migraine patients (frequent episodic and chronic), recruited at a specialised headache clinic, and 73 age and gender matched healthy controls following a standardised protocol. Eleven tests, previously identified in an international consensus procedure, were used to evaluate cervical and thoracic musculoskeletal dysfunctions. Results Primary analyses indicated statistically significant differences across groups for the total number of trigger points, flexion-rotation test, thoracic screening, manual joint testing of the upper cervical spine, cranio-cervical flexion test, and reproduction and resolution. Ninety three percent of the assessed patients had at least three musculoskeletal dysfunctions. Post-hoc tests showed significant differences between episodic or chronic migraine patients and healthy controls, but not between migraine groups. Conclusions A standardised set of six physical examination tests showed a high prevalence of musculoskeletal dysfunctions in migraine patients. These dysfunctions support a reciprocal interaction between the trigeminal and the cervical systems as a trait symptom in migraine.

24 Article The enigma of site of action of migraine preventives: no effect of metoprolol on trigeminal pain processing in patients and healthy controls. 2017

Hebestreit, Julia M / May, Arne. ·Department of Systems Neuroscience, Center for Experimental Medicine, University Medical Center Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. · Department of Systems Neuroscience, Center for Experimental Medicine, University Medical Center Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. a.may@uke.de. ·J Headache Pain · Pubmed #29285569.

ABSTRACT: BACKGROUND: Beta-blockers are a first choice migraine preventive medication. So far it is unknown how they exert their therapeutic effect in migraine. To this end we examined the neural effect of metoprolol on trigeminal pain processing in 19 migraine patients and 26 healthy controls. All participants underwent functional magnetic resonance imaging (fMRI) during trigeminal pain twice: Healthy subjects took part in a placebo-controlled, randomized and double-blind study, receiving a single dose of metoprolol and placebo. Patients were examined with a baseline scan before starting the preventive medication and 3 months later whilst treated with metoprolol. RESULTS: Mean pain intensity ratings were not significantly altered under metoprolol. Functional imaging revealed no significant differences in nociceptive processing in both groups. Contrary to earlier findings from animal studies, we did not find an effect of metoprolol on the thalamus in either group. However, using a more liberal and exploratory threshold, hypothalamic activity was slightly increased under metoprolol in patients and migraineurs. CONCLUSIONS: No significant effect of metoprolol on trigeminal pain processing was observed, suggesting a peripheral effect of metoprolol. Exploratory analyses revealed slightly enhanced hypothalamic activity under metoprolol in both groups. Given the emerging role of the hypothalamus in migraine attack generation, these data need further examination.

25 Article Topiramate modulates trigeminal pain processing in thalamo-cortical networks in humans after single dose administration. 2017

Hebestreit, Julia M / May, Arne. ·Department of Systems Neuroscience, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. ·PLoS One · Pubmed #28991914.

ABSTRACT: Migraine is the sixth most common cause of disability in the world. Preventive migraine treatment is used to reduce frequency, severity and duration of attacks and therefore lightens the burden on the patients' quality of life and reduces disability. Topiramate is one of the preventive migraine treatments of proven efficacy. The mechanism of action underlying the preventive effect of topiramate in migraine remains largely unknown. Using functional magnetic resonance imaging (fMRI) we examined the central effects of a single dose of topiramate (100mg) on trigeminal pain in humans, compared to placebo (mannitol). In this prospective, within subject, randomized, placebo-controlled and double-blind study, 23 healthy participants received a standardized nociceptive trigeminal stimulation and control stimuli whilst being in the scanner. No differences in the subjective intensity ratings of the painful stimuli were observed between topiramate and placebo sessions. In contrast, topiramate significantly decreased the activity in the thalamus and other pain processing areas. Additionally, topiramate increased functional coupling between the thalamus and several brain regions such as the bilateral precuneus, posterior cingulate cortex and secondary somatosensory cortex. These data suggest that topiramate exhibits modulating effects on nociceptive processing in thalamo-cortical networks during trigeminal pain and that the preventive effect of topiramate on frequent migraine is probably mediated by an effect on thalamo-cortical networks.

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