Har hodepinepasienter nytte av bli henvist til nevrolog

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Seasonal variation in migraine
Svein I. Bekkelund Department of
Neurology University Hospital of Tromsoe
15.02.07
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Migraine

• 10-12 of the population
• More common in women
• 2-3 headache attacks per months
• Duration of headache 4 hours to 3 days
• Unilateral severe headache, sickness, sensitivity
  to light and noise
• Headache 21 of patients referred to the
  department (Bekkelund 2002)

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(No Transcript)
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19.02.04
Daniel Hundstad (15yrs) reported worsening of
migraine in the arctic light season (april-july)
(Bekkelund/Lilleng, Cephalalgia 2006)
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Questionnaire

• 1403 patients referred to the departments of
  neurology in Tromsø and Bodø during 2 years
• 1052 answered
• Migraine n289
• Other headache types n653
• Endpoint better or worse during light or dark
  season

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Selfreported seasonal variation of migraine
headache light and dark season
(Salvesen/Bekkelund. Headache 2000)
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Subgroups of migraine

• Women with migraine selected by newspaper
  announcement
• 209 women included
• Diagnostic classification via telephone interview
• Migraine with aura n98
• Migraine without aura n71

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Seasonal variation of migraine headache in
subgroups with and without aura
(Alstadhaug, Salvesen, Bekkelund. Cephalalgia
2005)
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Results

• Intense light as a triggerfactor for attacks
• Migraine with aura 84 (86 )
• Migraine without aura 42 (59 ), plt0.001
• Use of sunglasses (between attacks)
• Migraine with aura 72 (74 )
• Migraine without aura 39 (55 ), p0.01

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Results

• Hypersensitive to light between attacks
• Migraine with aura 61 (62 )
• Migraine without aura 29 (41 ), p0.006

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(Alstadhaug. In press)
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(Alstadhaug. In press)
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Results..

• Hypothesis Is seasonal variation of migraine
  headache associated with menstrually-related
  migraine?
• Results
• Higher frequency of migraine attacks in those
  with menstrually-related migraine
• No differences between light and dark season

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Ideas

• fMRI in a subgroup of migraine patients with
  extreme light sensitivity (interictal
  sensitivity, use of sunglasses in the light
  season)
• Compare results with a group of patients without
  light sensitivity
• Endpoint anatomical response
• Other quantitative response?, pattern of
  respons?

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Challenge

• Create a fMRI model in migraine sensitive to
  light (response to light stimulus)
• Try to explore the mechanism intensity or
  accumulation of light?
• Are there differences in responses between
  periods of midnight-sun vs. complete darkness
  (abscence of the sun)?