Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Migraine Disorders: HELP
Articles from Klinikum Grosshadern
Based on 53 articles published since 2008
||||

These are the 53 published articles about Migraine Disorders that originated from Klinikum Grosshadern during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Editorial [Headache therapy - pain therapy: common features and differences]. 2014

Förderreuther, S / Straube, A. ·Klinik für Neurologie, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland. ·Schmerz · Pubmed #24718743.

ABSTRACT: -- No abstract --

2 Review Primary headaches during lifespan. 2019

Straube, Andreas / Andreou, Anna. ·Department of Neurology, University Hospital LMU, Ludwig-Maximilians-University, 81377, Munich, Germany. andreas.straube@med.uni-muenchen.de. · Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. · The Headache Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK. ·J Headache Pain · Pubmed #30961531.

ABSTRACT: Primary headaches are one of the most prevalent neurological disorders and can occur during a wide range of lifespan. Primary headaches, especially migraine, are cyclic disorders with a complex sequence of symptoms within every headache attack. There is no systematic review of whether these symptoms changes during lifespan. Indeed, the clinical presentation of migraine shows an age-dependent change with a significantly shorter duration of the attacks and occurrence of different paroxysmal symptoms, such as vomiting, abdominal pain or vertigo, in childhood and, in contrast, largely an absence of autonomic signs and a more often bilateral headache in the elderly. The age-dependent differences in the clinical presentation are less distinct in cluster headache and, especially, in tension-type headache. The differences in the clinical presentation are in agreement with the idea that the connectivity of hypothalamic areas with different brainstem areas, especially the central parasympathetic areas, is important for the clinical manifestation of migraine, as well as, the change during lifespan.

3 Review PACAP38 and PAC 2018

Rubio-Beltrán, Eloisa / Correnti, Edvige / Deen, Marie / Kamm, Katharina / Kelderman, Tim / Papetti, Laura / Vigneri, Simone / MaassenVanDenBrink, Antoinette / Edvinsson, Lars / Anonymous6340957. ·Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. a.rubiobeltran@erasmusmc.nl. · Department of Child Neuropsychiatry, University of Palermo, Palermo, Italy. · Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Glostrup, Denmark. · Department of Neurology, University Hospital, LMU Munich, Munich, Germany. · Department of Neurology, Ghent University Hospital, Ghent, Belgium. · Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. · Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo; Pain Medicine Unit, Santa Maria Maddalena Hospital, Occhiobello, Italy. · Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. · Department of Internal Medicine, Institute of Clinical Sciences, Lund University, Lund, Sweden. ·J Headache Pain · Pubmed #30088106.

ABSTRACT: Pituitary adenylate cyclase activating polypeptide-38 (PACAP38) is a widely distributed neuropeptide involved in neuroprotection, neurodevelopment, nociception and inflammation. Moreover, PACAP38 is a potent inducer of migraine-like attacks, but the mechanism behind this has not been fully elucidated.Migraine is a neurovascular disorder, recognized as the second most disabling disease. Nevertheless, the antibodies targeting calcitonin gene-related peptide (CGRP) or its receptor are the only prophylactic treatment developed specifically for migraine. These antibodies have displayed positive results in clinical trials, but are not effective for all patients; therefore, new pharmacological targets need to be identified.Due to the ability of PACAP38 to induce migraine-like attacks, its location in structures previously associated with migraine pathophysiology and the 100-fold selectivity for the PAC

4 Review [Modern non-cosmetic treatment with botulinum toxins]. 2017

Straube, A. ·Neurologische Klinik und Poliklinik, Klinikum der Universität, LMU München, Marchioninistr. 15, 81377, München, Deutschland. andreas.straube@med.uni-muenchen.de. ·Internist (Berl) · Pubmed #29030680.

ABSTRACT: Botulinum toxin has been known in medical history for a long time. The first scientific investigations and thoughts on possible indications in the treatment of muscular disorders were published by the German physician and poet Justinus Kerner in 1822. The physiological effect of botulinum toxin was identified in the middle of the twentieth century and the first clinical use was reported in 1977. It was first used in ophthalmology for the correction of strabismus and some years later the therapy of blepharospasm and cervical dystonia was established. Further indications, all supported by randomized controlled studies, are spastic tone increase of the limbs after lesions of the central nervous system, idiopathic axillar hyperhidrosis, chronic migraine and neurogenic or idiopathic bladder hyperactivity. In addition to these indications, a large number of further possible options have been published in the literature. Beside its effect on transmission at the neuromuscular synapses, botulinum toxin has also been shown to affect the sensory transmission of nociceptive fibers.

5 Review [Migraine in children and adolescents-brain and muscle? : Another example of why children are not small adults]. 2017

Landgraf, M N / König, H / Hannibal, I / Langhagen, T / Bonfert, M V / Klose, B / Rahmsdorf, B / Giese, R M / Straube, A / von Kries, R / Albers, L / Ebinger, F / Ertl-Wagner, B / Kammer, B / Körte, I / Sollmann, N / Krieg, S / Heinen, F. ·Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie, LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Universität München, Lindwurmstr. 4, 80337, München, Deutschland. mirjam.landgraf@med.uni-muenchen.de. · Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie, LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Universität München, Lindwurmstr. 4, 80337, München, Deutschland. · Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Campus Großhadern, Klinikum der Universität München, München, Deutschland. · Neurologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, München, Deutschland. · Institut für Soziale Pädiatrie und Jugendmedizin, Klinikum der Universität München, München, Deutschland. · Klinik für Kinder- und Jugendmedizin, St. Vincenz-Krankenhaus, Paderborn, Deutschland. · Klinik und Poliklinik für Radiologie, Campus Großhadern, Klinikum der Universität München, München, Deutschland. · Abteilung für Kinderradiologie, Klinik und Poliklinik für Radiologie, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Universität München, München, Deutschland. · Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Ludwig-Maximilians-Universität München, München, Deutschland. · Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. · Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. · Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland. · TUM-Neuroimaging Center und Klinik für Neurochirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland. · Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie, LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Universität München, Lindwurmstr. 4, 80337, München, Deutschland. florian.heinen@med.lmu.de. · Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Campus Großhadern, Klinikum der Universität München, München, Deutschland. florian.heinen@med.lmu.de. ·Nervenarzt · Pubmed #28956079.

ABSTRACT: Migraine as primary headache is a life-long disease which is relevant for the quality of life and is based on complex genetics. It often starts in childhood with symptoms typical for the specific age. These show different nuances compared to the migraine symptoms in adults, for example, regarding (bilateral/unilateral) localization of the acute migraine headache. Only over the course of years-during adolescence and young adulthood-do the more specific symptoms as defined by the International Classification of Headache Disorders (ICHD 3 beta) develop. In this article we focus on the clinical specifics of children and adolescents with migraine. We elaborately refer to the trigeminocervical complex (TCC) because it forms a conceptual bridge for the understanding of migraine, for psychoeducation, and for therapeutic options. We pragmatically discuss options and limits of treatments.

6 Review Blocking CGRP in migraine patients - a review of pros and cons. 2017

Deen, Marie / Correnti, Edvige / Kamm, Katharina / Kelderman, Tim / Papetti, Laura / Rubio-Beltrán, Eloisa / Vigneri, Simone / Edvinsson, Lars / Maassen Van Den Brink, Antoinette / Anonymous7800920. ·Danish Headache Center, Department of Neurology, Rigshospitalet, Copenhagen, Denmark. mariedeen85@gmail.com. · Department of Child Neuropsychiatry, University of Palermo, Palermo, Italy. · Department of Neurology, University Hospital, LMU, Munich, Germany. · Department of Neurology, Ghent University Hospital, Ghent, Belgium. · Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. · Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. · Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo; Advanced Algology Research and Pain Medicine Unit, Santa Maria Maddalena Hospital, Occhiobello, Italy. · Department of Internal Medicine, Institute of Clinical Sciences, Lund University, Lund, Sweden. ·J Headache Pain · Pubmed #28948500.

ABSTRACT: Migraine is the most prevalent neurological disorder worldwide and it has immense socioeconomic impact. Currently, preventative treatment options for migraine include drugs developed for diseases other than migraine such as hypertension, depression and epilepsy. During the last decade, however, blocking calcitonin gene-related peptide (CGRP) has emerged as a possible mechanism for prevention of migraine attacks. CGRP has been shown to be released during migraine attacks and it may play a causative role in induction of migraine attacks. Here, we review the pros and cons of blocking CGRP in migraine patients. To date, two different classes of drugs blocking CGRP have been developed: small molecule CGRP receptor antagonists (gepants), and monoclonal antibodies, targeting either CGRP or the CGRP receptor. Several trials have been conducted to test the efficacy and safety of these drugs. In general, a superior efficacy compared to placebo has been shown, especially with regards to the antibodies. In addition, the efficacy is in line with other currently used prophylactic treatments. The drugs have also been well tolerated, except for some of the gepants, which induced a transient increase in transaminases. Thus, blocking CGRP in migraine patients is seemingly both efficient and well tolerated. However, CGRP and its receptor are abundantly present in both the vasculature, and in the peripheral and central nervous system, and are involved in several physiological processes. Therefore, blocking CGRP may pose a risk in subjects with comorbidities such as cardiovascular diseases. In addition, long-term effects are still unknown. Evidence from animal studies suggests that blocking CGRP may induce constipation, affect the homeostatic functions of the pituitary hormones or attenuate wound healing. However, these effects have so far not been reported in human studies. In conclusion, this review suggests that, based on current knowledge, the pros of blocking CGRP in migraine patients exceeds the cons.

7 Review [Syncope, transient ischemic attacks, transient global amnesia and migraine]. 2017

Hartl, E. ·Epilepsie-Zentrum, Neurologische Klinik und Poliklinik, Klinikum der Universität München-Großhadern, Ludwig-Maximilians-Universität, München-Großhadern, Deutschland. elisabeth.hartl@med.uni-muenchen.de. ·Nervenarzt · Pubmed #28849251.

ABSTRACT: Epileptic seizures can manifest with a variety of clinical symptoms. Depending on the dominant symptom, several differential diagnoses have to be considered. Their differentiation can be challenging, especially after the first episode. The review article summarizes the most common differential diagnoses as well as their characteristics compared to epileptic seizures, aiming at providing guidelines for their clinical differentiation. Whenever a clear diagnosis is not possible based on the patient history and clinical signs, diagnostic evaluation with, e. g. an electroencephalogram (EEG) and finally EEG video monitoring can be helpful.

8 Review [Diagnosis of non-epileptic paroxysmal disorders and epileptic seizures]. 2017

Noachtar, S / Güldiken, B. ·Epilepsie-Zentrum, Neurologische Klinik und Poliklinik, Klinikum der Universität München-Großhadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, München, Deutschland. noa@med.uni-muenchen.de. · Neurologische Klinik, Medizinische Fakultät, Trakya Universität, Edirne, Türkei. ·Nervenarzt · Pubmed #28842725.

ABSTRACT: Non-epileptic paroxysmal disorders may clinically manifest in a similar way to epileptic seizures and have to be considered in the differential diagnosis of epilepsy. Syncope, non-epileptic psychogenic seizures, paroxysmal movement disorders, migraine, transient ischemic attacks and parasomnia constitute the major differential diagnoses. A meticulous history and a third party description are useful for the differential diagnosis. Neurological, psychiatric and cardiological examinations are required for the correct differential diagnosis. The interictal electroencephalogram (EEG), which is normal in non-epileptic patients, is frequently normal in epileptic patients at the onset of seizures, but reaches a high sensitivity after repeated recordings. In equivocal cases EEG video monitoring and in the case of suspected cardiac asystole, event recorders are useful diagnostic tools.

9 Review Persistent and Repetitive Visual Disturbances in Migraine: A Review. 2017

Schankin, Christoph J / Viana, Michele / Goadsby, Peter J. ·Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. · Department of Neurology, Grosshadern, University Hospital Munich, University of Munich, Munich, Germany. · Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy. · Headache Group, NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, United Kingdom. ·Headache · Pubmed #27714802.

ABSTRACT: Visual disturbances in migraineurs, such as visual aura, are typically episodic, that is, associated with the headache attack, and overlaid by head pain and other symptoms that impact the patient. In some patients, however, visual symptoms are dominant due to frequency (migraine aura status), duration (persistent migraine aura and other persistent positive visual phenomena), or complexity (visual snow syndrome). These syndromes are more rare and challenging to classify in clinical practice resulting in a lack of systematic studies on pathophysiology and treatment. We aim at describing clinical features and pathophysiological concepts of typical migraine aura with a focus on cortical spreading depression and differentiation from non-typical migraine aura. Additionally, we discuss nomenclature and the specifics of migraine aura status, persistent migraine aura, persistent positive visual phenomena, visual snow, and other migrainous visual disturbances. The term migraine with prolonged aura might be a useful bridge between typical aura and persistent aura. Further studies would be necessary to assess whether a return of the classification category eventually helps diagnosing or treating patients more effectively. A practical approach is presented to help the treating physician to assign the correct diagnosis and to choose a medication for treatment that has been successful in case reports of these rare but disabling conditions.

10 Review Vestibular Migraine in Children and Adolescents. 2016

Langhagen, Thyra / Landgraf, Mirjam N / Huppert, Doreen / Heinen, Florian / Jahn, Klaus. ·Department of Paediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Lindwurmstr. 4, 80337, Munich, Germany. thyra.langhagen@med.uni-muenchen.de. · German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany. thyra.langhagen@med.uni-muenchen.de. · Department of Paediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Lindwurmstr. 4, 80337, Munich, Germany. · German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany. · Schön Klinik Bad Aibling, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany. ·Curr Pain Headache Rep · Pubmed #27873123.

ABSTRACT: PURPOSE OF REVIEW: The goal of this review is to provide an actualized overview on vestibular migraine in childhood and adolescence, with focus on the epidemiology and clinical presentation as well as its treatment. RECENT FINDINGS: Vertigo spells in childhood can evolve into other periodic syndromes and/or migraine types and persist even into adulthood. Vestibular migraine (VM) and benign paroxysmal vertigo are the most common causes of vertigo in children and adolescents. The diagnostic criteria for VM are dizziness and vertigo, headache, phonophobia and photophobia, and visual aura. The prevention of attacks is the treatment for children and adolescents with VM, as is recommended for migraine with or without aura. Thus, non-pharmacological measures are the first-line option; when these measures fail or daily activities are notably affected, drugs are administrated. Psychological assessment and cognitive behavioral therapy are also important therapeutic measures in this patient group. There is still insufficient research on VM in children and adolescents; future studies on clinical presentation, evolvement, and specific treatment are necessary.

11 Review [Headache. Current status of research and treatment]. 2015

Straube, A / Gaul, C. ·Neurologische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland. andreas.straube@med.uni-muenchen.de. · Migräne- und Kopfschmerzklinik Königstein, Königstein, Deutschland. ·Schmerz · Pubmed #26264901.

ABSTRACT: The starting point for German headache research and clinical education was the engagement of D. Soyka in the 1970s, which enabled the foundation of the German Headache Society (DMKG) on 28 June 1979 and, some years later, the founding congress of the International Headache Society (IHS) in Munich 1982. As a result of these activities, in 1988 the first international classification of headache disorders was published. This classification was one of the major milestones in the development of basic as well as clinical headache research. In the following years, epidemiological studies all over the world showed a 1-year prevalence for headache of approximately 60%, making headaches one of the most frequent medical complaints. Basic research showed an involvement of serotonergic mechanisms in migraine pain and triptans were one of the first drugs designed to influence these mechanisms. Functional brain imaging studies in migraine patients further showed a cyclic modulation of the activity of brainstem areas independent of the current pain state. Various research groups were involved in the clarification of the role of calcitonin gene-related peptide (CGRP) in migraine and cluster headache. A specific development in the German headache scene is the establishment of integrated headache centers and reflects the primarily multimodal treatment approach in Germany which contrasts with the settings in other countries. These successful developments are increasingly being undermined by the fact that the low financial support of headache research, for example, by the German science council is causing a decreasing interest in headache research, with the consequence that the clinical education of students as well as young medical doctors shows increasing deficits. The consequence for the future will be a deficit in the clinical care of the population.

12 Review Visual snow--persistent positive visual phenomenon distinct from migraine aura. 2015

Schankin, Christoph J / Goadsby, Peter J. ·Department of Neurology, University of Munich Hospital-Großhadern, Marchioninistr. 15, 81377, Munich, Germany, christoph.schankin@med.uni-muenchen.de. ·Curr Pain Headache Rep · Pubmed #26021756.

ABSTRACT: Patients with visual snow complain of uncountable flickering tiny dots in the entire visual field similar to the view of a badly tuned analogue TV channel (TV snow). The symptoms are often continuous and can persist over years. This condition is grouped among the persistent visual phenomena in migraine, although it clinically presents a unique entity distinct from persistent migraine aura or migraine aura status. Here, we review the recent literature leading to the identification of the visual snow syndrome. The additional visual and non-visual symptoms are described in detail, and criteria are presented for future studies. Using these criteria, the relationship to migraine and typical migraine aura was recently evaluated. Further, patients with visual snow differ from controls in respect of hypermetabolism in the supplementary visual cortex (lingual gyrus). This provides evidence that visual snow, despite being purely subjective in the individual patient, has a clear biological basis. The area of hypermetabolism overlaps with the functional correlates of photophobia in migraine supporting the close relationship of migraine and visual snow.

13 Review From ophthalmoplegic migraine to cranial neuropathy. 2015

Förderreuther, Stefanie / Ruscheweyh, Ruth. ·Department of Neurology, Klinikum Großhadern, Ludwig-Maximilians University, Munich, Germany, steffi.foerderreuther@med.uni-muenchen.de. ·Curr Pain Headache Rep · Pubmed #26021754.

ABSTRACT: Ophthalmoplegic migraine (OM)/recurrent painful ophthalmoplegic neuropathy (RPON) is a rare disease consisting of recurrent unilateral headache accompanied or followed by ipsilateral ophthalmoplegia. Because MRI findings suggest neuropathy and the relationship to typical migraine remains unclear, the disease has been renamed from "ophthalmoplegic migraine" to "recurrent painful oculomotor neuropathy" in the third edition of the International Classification of Headache Disorders (ICHD). However, it remains a fact that most cases of OM/RPON described in the literature have a history of migraine and that the headache during OM/RPON often has migrainous features. A more detailed clinical description of the headache during OM/RPON and additional results from imaging and possibly histology will be needed to better understand the pathophysiology of the disease and its relationship to typical migraine.

14 Review The premonitory phase of migraine--what can we learn from it? 2015

Maniyar, Farooq H / Sprenger, Till / Monteith, Teshamae / Schankin, Christoph J / Goadsby, Peter J. ·Department of Neurology, Basildon and Thurrock University Hospitals, Essex, UK. · Department of Neurology, Royal London Hospital, London, UK. · Department of Neurology and Division of Neuroradiology, University Hospital Basel, Basel, Switzerland. · Department of Neurology, University of Miami, Miami, FL, USA. · Department of Neurology, University of Munich Hospital - Großhadern, Munich, Germany. · Department of Neurology, University of California, San Francisco, San Francisco, CA, USA. ·Headache · Pubmed #25919990.

ABSTRACT: This review aims to understand the prevalence of premonitory symptoms in migraine, postulate their mechanisms, and compare these with functional imaging studies. A thorough literature review was conducted using PubMed for prevalence studies of premonitory symptoms in migraine and functional imaging studies in the premonitory phase. The majority of studies have been retrospective reporting a prevalence of 7-88% for premonitory symptoms in migraine. Only one study has investigated premonitory symptoms prospectively and used preselected patients with recognized premonitory symptoms. The majority of patients were able to predict correctly the onset of migraine headache. Only one functional imaging study has been conducted in the premonitory phase that showed activation of posterolateral hypothalamus, midbrain tegmental area and substantia nigra, periaqueductal gray, dorsal pons, and various cortical areas including occipital, temporal, and prefrontal cortex. Subgroup analysis of patients with photophobia more than without photophobia in the premonitory phase showed activation of the occipital cortex. Comparison of patients with nausea more than without nausea in the premonitory phase showed activation in upper dorsal medulla and periaqueductal gray. Premonitory symptoms are common in migraine, although the true prevalence cannot be stated with certainty in the absence of prospective studies in unselected patients. Hypothalamic involvement can explain many of the premonitory symptoms. Activation of the the brainstem structures and hypothalamus before pain suggests a pivotal role of these structures in the pathogenesis of migraine. Hypersensitivity to light and occurrence of nausea in migraine is associated with activation of central brain structures involved in these pathways, and this can occur in the absence of pain.

15 Review Vertigo and dizziness in children. 2015

Jahn, Klaus / Langhagen, Thyra / Heinen, Florian. ·aGerman Center for Vertigo and Balance Disorders (DSGZ) bDepartment of Neurology cDepartment of Paediatric Neurology and Developmental Medicine - Dr von Hauner Children's Hospital, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany. ·Curr Opin Neurol · Pubmed #25502049.

ABSTRACT: PURPOSE OF REVIEW: Vertigo and dizziness occur with considerable frequency in childhood and adolescence. Most causes are benign and treatable. This review aims to make physicians more alert to the frequent causes of dizziness in the young. RECENT FINDINGS: Epidemiological data confirm that migraine-related syndromes are the most common cause of vertigo in children. Vestibular migraine and benign paroxysmal vertigo have now been defined by the International Classification of Headache Disorders. About half of the adolescents with vertigo and dizziness show psychiatric comorbidity and somatization. Vestibular paroxysmia has been described as a new entity in children that can be treated with low doses of carbamazepine. To assess vestibular deficits, video head impulses (for the semicircular canals) and vestibular-evoked myogenic potentials (for the otoliths) are increasingly being used. SUMMARY: Pediatricians and neuro-otologists should be aware of the full spectrum of causes of vertigo and dizziness in children and adolescents. Vestibular function can reliably be tested nowadays. Although treatment for the common migraine-related syndromes can be done in analogy to the treatment of migraine in general, specific approaches are required for somatoform vertigo, the most frequent diagnosis in adolescent girls.

16 Review Differential effectiveness of placebo treatments: a systematic review of migraine prophylaxis. 2013

Meissner, Karin / Fässler, Margrit / Rücker, Gerta / Kleijnen, Jos / Hróbjartsson, Asbjorn / Schneider, Antonius / Antes, Gerd / Linde, Klaus. ·Institute of General Practice, Klinikum rechts der Isar, Technische Universität München, Munich, Germany2Institute of Medical Psychology, Ludwig-Maximilians-University Munich, Munich, Germany. ·JAMA Intern Med · Pubmed #24126676.

ABSTRACT: IMPORTANCE: When analyzing results of randomized clinical trials, the treatment with the greatest specific effect compared with its placebo control is considered to be the most effective one. Although systematic variations of improvements in placebo control groups would have important implications for the interpretation of placebo-controlled trials, the knowledge base on the subject is weak. OBJECTIVE: To investigate whether different types of placebo treatments are associated with different responses using the studies of migraine prophylaxis for this analysis. DESIGN, SETTING, AND PARTICIPANTS: We searched relevant sources through February 2012 and contacted the authors to identify randomized clinical trials on the prophylaxis of migraine with an observation period of at least 8 weeks after randomization that compared an experimental treatment with a placebo control group. We calculated pooled random-effects estimates according to the type of placebo for the proportions of treatment response. We performed meta-regression analyses to identify sources of heterogeneity. In a network meta-analysis, direct and indirect comparisons within and across trials were combined. Additional analyses were performed for continuous outcomes. EXPOSURE: Active migraine treatment and the placebo control conditions. MAIN OUTCOMES AND MEASURES: Proportion of treatment responders, defined as having an attack frequency reduction of at least 50%. Other available outcomes in order of preference included a reduction of 50% or greater in migraine days, the number of headache days, or headache score or a significant improvement as assessed by the patients or their physicians. RESULTS: Of the 102 eligible trials, 23 could not be included in the meta-analyses owing to insufficient data. Sham acupuncture (proportion of responders, 0.38 [95% CI, 0.30-0.47]) and sham surgery (0.58 [0.37-0.77]) were associated with a more pronounced reduction of migraine frequency than oral pharmacological placebos (0.22 [0.17-0.28]) and were the only significant predictors of response in placebo groups in multivariable analyses (P = .005 and P = .001, respectively). Network meta-analysis confirmed that more patients reported response in sham acupuncture groups than in oral pharmacological placebo groups (odds ratio, 1.88 [95% CI, 1.30-2.72]). Corresponding analyses for continuous outcomes showed similar findings. CONCLUSIONS AND RELEVANCE: Sham acupuncture and sham surgery are associated with higher responder ratios than oral pharmacological placebos. Clinicians who treat patients with migraine should be aware that a relevant part of the overall effect they observe in practice might be due to nonspecific effects and that the size of such effects might differ between treatment modalities.

17 Review Headache in children: update on complementary treatments. 2013

Schetzek, Stefanie / Heinen, Florian / Kruse, Sigrid / Borggraefe, Ingo / Bonfert, Michaela / Gaul, Charly / Gottschling, Sven / Ebinger, Friedrich. ·Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Munich, Germany. stefanie.schetzek@med.uni-muenchen.de ·Neuropediatrics · Pubmed #23315555.

ABSTRACT: Complementary and alternative medicine (CAM) is widely used by both physicians and patients with primary headache syndromes. Despite a considerable number of articles addressing CAM in primary headache syndromes, the overall evidence for CAM is still poor. The aim of this review was to give an overview of the current evidence of the main alternative therapies used in the treatment of primary headache syndromes of childhood. MEDLINE and Cochrane Library were systematically searched for articles dealing with complementary and alternative treatment or prophylaxis of headache and migraine published within the past 20 years.

18 Review Primary headache in children and adolescents: update on pharmacotherapy of migraine and tension-type headache. 2013

Bonfert, Michaela / Straube, Andreas / Schroeder, Andreas Sebastian / Reilich, Peter / Ebinger, Friedrich / Heinen, Florian. ·Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany. michaela.bonfert@med.uni-muenchen.de ·Neuropediatrics · Pubmed #23303551.

ABSTRACT: Primary headache disorders are frequently encountered in the pediatric population. The therapeutic approach consists of a multimodal program, including lifestyle modification, psychotherapeutic intervention, pharmacotherapy, and complementary measures. This systematic review focuses on the pharmacotherapy of pediatric migraine and tension-type headache (TTH). In addition to the general treatment principles, the results of 33 clinical reports published on the topic since 2008 are outlined in detail. Furthermore, a tabular summary of previously investigated agents not studied since 2008 is given, as is an overview of promising pharmacologic approaches so far only evaluated in adults. A variety of pharmacologic options is available, but high-quality evidence is limited to single agents. At this time, approval is restricted to four triptans and flupirtine for the symptomatic treatment of pediatric acute migraine and TTH, respectively. No agent has been approved for the prevention of pediatric primary headaches. This review does not grade the drugs hierarchically because the complex profiles of many agents differ only slightly or even overlap. However, a detailed expert opinion is provided. On the basis of the outlined facts, the team of physician, patient, and parents has to decide on the most appropriate regimen for the individual situation in the sense of personalized medicine.

19 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.

20 Review [Headache in the elderly]. 2008

Reinisch, V M / Schankin, C J / Felbinger, J / Sostak, P / Straube, A. ·Oberbayerisches Kopfschmerzzentrum, Neurologische Klinik und Poliklinik, Klinikum Grosshadern der Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377, München, Germany. veronika.reinisch@med.uni-muenchen.de ·Schmerz · Pubmed #18228047.

ABSTRACT: Chronic headache is still a frequent problem in old age, affecting about 10% of all women and 5% of all men older than 70 years. The incidence of primary headache decreases with advancing age, while that of secondary headache increases. The clinical characteristics of migraine can also change with age; for example, vegetative symptoms are less prominent, and less intense migrainous pain localized predominantly in the neck is frequently reported. Migraine aura can also be experienced more frequently in isolation, without a headache. Hypnic headache is a rare primary headache syndrome that occurs almost exclusively in the elderly. Most of the secondary headache syndromes that occur more frequently in old age present clinically as tension-type headache. Examples of rather common reasons for secondary headache syndromes in the elderly are intracranial space-occupying lesions, ophthalmological problems and autoimmune diseases such as giant cell arteritis. Elderly patients are especially likely to have a number of illnesses at any one time for which they take various medications each day, so that headaches can also quite often be caused by their medication or by withdrawal of these. As a result of such multimorbidity the homeostasis is disturbed in such patients, leading to various conditions that can entail concomitant headaches (sleep apnoea syndrome, dialysis headache, headache attributed to arterial hypertension or hypothyroidism). Familiar facial neuralgias, such as trigeminal neuralgia or postherpetic neuralgia following manifest herpes zoster affecting the face, become markedly more frequent with age. In general, in the treatment of headaches in the elderly it is essential to pay careful attention to potential interactions with the multiple drugs needed because of other diseases; in addition, the comorbidities themselves have to be taken into account, especially depression, anxiety and cognitive impairment, necessitating multimodal, interdisciplinary therapy plans.

21 Article Quantitative magnetic resonance imaging of the upper trapezius muscles - assessment of myofascial trigger points in patients with migraine. 2019

Sollmann, Nico / Mathonia, Nina / Weidlich, Dominik / Bonfert, Michaela / Schroeder, Sebastian A / Badura, Katharina A / Renner, Tabea / Trepte-Freisleder, Florian / Ganter, Carl / Krieg, Sandro M / Zimmer, Claus / Rummeny, Ernst J / Karampinos, Dimitrios C / Baum, Thomas / Landgraf, Mirjam N / Heinen, Florian. ·Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. Nico.Sollmann@tum.de. · TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Nico.Sollmann@tum.de. · Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU - University Hospital, Ludwig-Maximilians-Universität, Lindwurmstr. 4, 80337, Munich, Germany. · Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. · TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. · Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. · Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. ·J Headache Pain · Pubmed #30658563.

ABSTRACT: BACKGROUND: Research in migraine points towards central-peripheral complexity with a widespread pattern of structures involved. Migraine-associated neck and shoulder muscle pain has clinically been conceptualized as myofascial trigger points (mTrPs). However, concepts remain controversial, and the identification of mTrPs is mostly restricted to manual palpation in clinical routine. This study investigates a more objective, quantitative assessment of mTrPs by means of magnetic resonance imaging (MRI) with T2 mapping. METHODS: Ten subjects (nine females, 25.6 ± 5.2 years) with a diagnosis of migraine according to ICHD-3 underwent bilateral manual palpation of the upper trapezius muscles to localize mTrPs. Capsules were attached to the skin adjacent to the palpated mTrPs for marking. MRI of the neck and shoulder region was performed at 3 T, including a T2-prepared, three-dimensional (3D) turbo spin echo (TSE) sequence. The T2-prepared 3D TSE sequence was used to generate T2 maps, followed by manual placement of regions of interest (ROIs) covering the trapezius muscles of both sides and signal alterations attributable to mTrPs. RESULTS: The trapezius muscles showed an average T2 value of 27.7 ± 1.4 ms for the right and an average T2 value of 28.7 ± 1.0 ms for the left side (p = 0.1055). Concerning signal alterations in T2 maps attributed to mTrPs, nine values were obtained for the right (32.3 ± 2.5 ms) and left side (33.0 ± 1.5 ms), respectively (p = 0.0781). When comparing the T2 values of the trapezius muscles to the T2 values extracted from the signal alterations attributed to the mTrPs of the ipsilateral side, we observed a statistically significant difference (p = 0.0039). T2 hyperintensities according to visual image inspection were only reported in four subjects for the right and in two subjects for the left side. CONCLUSIONS: Our approach enables the identification of mTrPs and their quantification in terms of T2 mapping even in the absence of qualitative signal alterations. Thus, it (1) might potentially challenge the current gold-standard method of physical examination of mTrPs, (2) could allow for more targeted and objectively verifiable interventions, and (3) could add valuable models to understand better central-peripheral mechanisms in migraine.

22 Article Molecular genetic overlap between migraine and major depressive disorder. 2018

Yang, Yuanhao / Zhao, Huiying / Boomsma, Dorret I / Ligthart, Lannie / Belin, Andrea C / Smith, George Davey / Esko, Tonu / Freilinger, Tobias M / Hansen, Thomas Folkmann / Ikram, M Arfan / Kallela, Mikko / Kubisch, Christian / Paraskevi, Christofidou / Strachan, David P / Wessman, Maija / Anonymous2051131 / van den Maagdenberg, Arn M J M / Terwindt, Gisela M / Nyholt, Dale R. ·Statistical and Genomic Epidemiology Laboratory, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia. y.yang@imb.uq.edu.au. · Institute of Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia. y.yang@imb.uq.edu.au. · Statistical and Genomic Epidemiology Laboratory, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia. · Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China. · Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands. · Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden. · Medical Research Council (MRC) Integrative Epidemiology Unit, University of Bristol, Bristol, UK. · Medical and Population Genetics Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA. · Estonian Genome Center, University of Tartu, Tartu, Estonia. · Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA. · Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany. · Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany. · Danish Headache Center, Department of Neurology, Rigshospitalet, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands. · Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. · Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. · Department of Twin Research and Genetic Epidemiology, King's College London, London, UK. · Population Health Research Institute, St George's, University of London, London, UK. · Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland. · Folkhälsan Institute of Genetics, Helsinki, Finland. · Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands. · Statistical and Genomic Epidemiology Laboratory, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia. d.nyholt@qut.edu.au. ·Eur J Hum Genet · Pubmed #29995844.

ABSTRACT: Migraine and major depressive disorder (MDD) are common brain disorders that frequently co-occur. Despite epidemiological evidence that migraine and MDD share a genetic basis, their overlap at the molecular genetic level has not been thoroughly investigated. Using single-nucleotide polymorphism (SNP) and gene-based analysis of genome-wide association study (GWAS) genotype data, we found significant genetic overlap across the two disorders. LD Score regression revealed a significant SNP-based heritability for both migraine (h

23 Article The cold pressor test in interictal migraine patients - different parasympathetic pupillary response indicates dysbalance of the cranial autonomic nervous system. 2018

Eren, Ozan E / Ruscheweyh, Ruth / Schankin, Christoph / Schöberl, Florian / Straube, Andreas. ·Department of Neurology, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany. ozan.eren@med.uni-muenchen.de. · Department of Neurology, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany. · Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. ·BMC Neurol · Pubmed #29661162.

ABSTRACT: BACKGROUND: Data on autonomic nervous system (ANS) activations in migraine patients are quite controversial, with previous studies reporting over- and underactivation of the sympathetic as well as parasympathetic nervous system. In the present study, we explicitly aimed to assess the cranial ANS in migraine patients compared to healthy controls by applying the cold pressor test to a cohort of migraine patients in the interictal phase and measuring the pupillary response. METHODS: In this prospective observational study, a strong sympathetic stimulus was applied to 20 patients with episodic migraine in the interictal phase and 20 matched controls without migraine, whereby each participant dipped the left hand into ice-cold (4 °C) water for a maximum of 5 min (cold pressor test). At baseline, 2, and 5 min during the cold pressor test, infrared monocular pupillometry was applied to quantify pupil diameter and light reflex parameters. Simultaneously, heart rate and blood pressure were measured by the external brachial RR-method at distinct time intervals to look for at least clinically relevant changes of the cardiovascular ANS. RESULTS: There were no significant differences between the migraine patients and controls at baseline and after 2 min of sympathetic stimulation in all the measured pupillary and cardio-vascular parameters. However, at 5 min, pupillary light reflex (PLR) constriction velocity was significantly higher in migraineurs than in controls (5.59 ± 0.73 mm/s vs. 5.16 ± 0.53 mm/s; unpaired t-test p < 0.05), while both cardiovascular parameters and PLR dilatation velocity were similar in both groups at this time point. CONCLUSIONS: Our findings of an increased PLR constriction velocity after sustained sympathetic stimulation in interictal migraine patients suggest an exaggerated parasympathetic response of the cranial ANS. This indicates that brainstem parasympathetic dysregulation might play a significant role in migraine pathophysiology. More dedicated examination of the ANS in migraine patients might be of value for a deeper understanding of its pathophysiology.

24 Article Children with migraine: Provocation of headache via pressure to myofascial trigger points in the trapezius muscle? - A prospective controlled observational study. 2018

Landgraf, M N / Biebl, J T / Langhagen, T / Hannibal, I / Eggert, T / Vill, K / Gerstl, L / Albers, L / von Kries, R / Straube, A / Heinen, F. ·Department of Paediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany. · German Vertigo and Balance Center (DSGZ), Ludwig-Maximilians-University, Munich, Germany. · Department of Neurology, Campus Grosshadern, Ludwig-Maximilians-University, Munich, Germany. · Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University, Munich, Germany. ·Eur J Pain · Pubmed #28952174.

ABSTRACT: BACKGROUND: The objective was to evaluate a supposed clinical interdependency of myofascial trigger points and migraine in children. Such interdependency would support an interaction of spinal and trigeminal afferences in the trigemino-cervical complex as a contributing factor in migraine. METHODS: Children ≤18 years with the confirmed diagnosis of migraine were prospectively investigated. Comprehensive data on medical history, clinical neurological and psychological status were gathered. Trigger points in the trapezius muscle were identified by palpation and the threshold of pressure pain at these points was measured. Manual pressure was applied to the trigger points, and the occurrence and duration of induced headache were recorded. At a second consultation (4 weeks after the first), manual pressure with the detected pressure threshold was applied to non-trigger points within the same trapezius muscle (control). Headache and related parameters were again recorded and compared to the results of the first consultation. RESULTS: A total of 13 girls and 13 boys with migraine and a median age of 14.5 (Range 6.3-17.8) years took part in the study. Manual pressure to trigger points in the trapezius muscle led to lasting headache after termination of the manual pressure in 13 patients while no patient experienced headache when manual pressure was applied to non-trigger points at the control visit (p < 0.001). Headache was induced significantly more often in children ≥12 years and those with internalizing behavioural disorder. CONCLUSION: We found an association between trapezius muscle myofascial trigger points and migraine, which might underline the concept of the trigemino-cervical complex, especially in adolescents. SIGNIFICANCE: In children with migraine headache can often be induced by pressure to myofascial trigger points, but not by pressure to non-trigger points in the trapezius muscle. This supports the hypothesis of a trigemino-cervical-complex in the pathophysiology of migraine, which might have implications for innovative therapies in children with migraine.

25 Article Vertigo and dizziness in adolescents: Risk factors and their population attributable risk. 2017

Filippopulos, Filipp M / Albers, Lucia / Straube, Andreas / Gerstl, Lucia / Blum, Bernhard / Langhagen, Thyra / Jahn, Klaus / Heinen, Florian / von Kries, Rüdiger / Landgraf, Mirjam N. ·Department of Neurology, University Hospital, LMU, Munich, Germany. · German Center for Vertigo and Balance Disorders, LMU, Munich, Germany. · Institute of Social Paediatrics and Adolescents Medicine, Division of Epidemiology, LMU, Munich, Germany. · Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, LMU, Munich, Germany. · Department of Neurology, Schön Klinik Bad Aibling, Bad Aibling, Germany. ·PLoS One · Pubmed #29131843.

ABSTRACT: OBJECTIVES: To assess potential risk factors for vertigo and dizziness in adolescents and to evaluate their variability by different vertigo types. The role of possible risk factors for vertigo and dizziness in adolescents and their population relevance needs to be addressed in order to design preventive strategies. STUDY DESIGN: The study population consisted of 1482 school-children between the age of 12 and 19 years, who were instructed to fill out a questionnaire on different vertigo types and related potential risk factors. The questionnaire specifically asked for any vertigo, spinning vertigo, swaying vertigo, orthostatic dizziness, and unspecified dizziness. Further a wide range of potential risk factors were addressed including gender, stress, muscular pain in the neck and shoulder region, sleep duration, migraine, coffee and alcohol consumption, physical activity and smoking. RESULTS: Gender, stress, muscular pain in the neck and shoulder region, sleep duration and migraine were identified as independent risk factors following mutual adjustment: The relative risk was 1.17 [1.10-1.25] for female sex, 1.07 [1.02-1.13] for stress, 1.24 [1.17-1.32] for muscular pain, and 1.09 [1.03-1.14] for migraine. The population attributable risk explained by these risk factors was 26%, with muscular pain, stress, and migraine accounting for 11%, 4%, and 3% respectively. CONCLUSION: Several established risk factors in adults were also identified in adolescents. Risk factors amenable to prevention accounted for 17% of the total population risk. Therefore, interventions targeting these risk factors may be warranted.

Next