Principal Investigator: Kevin Brennan
Keywords: Headache , Migraine , endophenotypes Department: Neurology
IRB Number: 00064447
Specialty: Neurology, Neurology, Neurology
Sub Specialties: General Neurology, Headache
Recruitment Status: Active, not recruiting

Contact Information

Matthew Halverson

Simple Summary

Migraine and post-traumatic headache are clinically heterogeneous groups, often with complex symptom complements that are difficult to link to currently accepted pathophysiology of headache. This project proposes to investigate endophenotypes within migraine and post-traumatic headache compared to normal controls. To accomplish this, we will employ a battery of clinical, imaging, physiological, and psychometric measures to each group. Specifically, we will assess fMRI, cortical motion perception, facial autonomic function, allodynia, photophobia, and neuropsychometric testing in the follow ing five patient groups: normal control, migraine with aura, migraine w ithout aura, migrainous vertigo, and post-traumatic headache.We anticipate that our work will aid in the understanding and classification of migraine by physiologically characterizing migraine endophenotypes. This approach, if successful, can serve as a model for characterization of other migraine subtypes. Additionally, our multiple data streams should provide new information on migraine physiology and potential comparative measures between clinically overlapping groups. Finally, our proposal has the potential to generate physiologically defined measures of migraine treatment, which in turn could help in the testing of rationally generated migraine treatment. This project is part of a larger multifaceted effort to define, understand, and subsequently treat migraine. These methods can be applied to other subsets of migraines to aid in identifying other migraine endophenotypes.

Inclusion Criteria

A total of 300 participants will be recruited, divided among the following groups: MV, MA, migraine without aura (MO), post-traumatic headache (PTH), chronic migraine, trigeminal cephalgia, and age and sex-matched controls. All participants will be evaluated by a headache provider. Patients will be screened using a standard clinical questionnaire; diagnostic characterization is determined based on this questionnaire. Symptoms and relevant comorbidities are also obtained via the questionnaire. 

Inclusion criteria for each group will be MV (as defined above), migraine with aura without vertigo, migraine without aura, post-traumatic headache, chronic migraine, and trigeminal cephalgia (each as defined by the recently updated ICHD-III beta diagnostic criteria, summarized in brief below), and normal, non-headache controls.

The criteria for the diagnosis of migraine are as follows:

  1. Migraine with aura (MA): At least 2 episodes of aura symptoms including visual disturbances prior to the onset of headache and fulfilling criteria for migraine, as in migraine without aura below.
  2. Migraine without aura (MO):  At least 5 episodes of moderate to severe headache with all of the following:
    1. Pulsating or one-sided headache
    2. Associated with nausea and/or vomiting and/or hypersensitivity to light or sound
    3. Headache exacerbated by movement or similar physical activity
    4. Headache lasting 4-72 hours
  3. Probable Migraine (MP). At least 5 episodes of moderate to severe headache with only 3 of the features listed above under 2a-d.
  4. Other headaches (OH). Recurrent headaches that do not fulfill the criteria for any form of migraine.
  5. No recurrent headaches (NH).
  6. Chronic migraine (CM). Those meeting diagnostic criteria for #1 or #2 above, with headache occurring >15 days per month.
  7. Trigeminal cephalgia: headache or facial pain occurring with at least one or more craniofacial autonomic symptom ipsilateral to the head pain.

Post-traumatic headache as follows:

  1. Headache fulfilling criteria 2 and/or 3, no typical characteristics required
  2. Head trauma with all the following:
    1. Either no loss of consciousness, or loss of consciousness of less than 30 minutes’ duration
  3. Symptoms and/or signs diagnostic of concussion
  4. Headache develops within 7 days after head trauma
  5. One or other of the following:
    1. Headache resolves within 3 months after head trauma
    2. Headache persists but 3 months have not yet passed since head trauma

For complete diagnostic criteria, we will refer to the following published guideline: Headache Classification Committee of the IHS. ICHD 3rd edition, beta version. Cephalgia (2013). 33(9) 629-808.

Exclusion Criteria

Exclusion criteria will be age under 18 years, conditions which could increase the risk of fMRI procedures, or those with medical conditions or who are on medications (that cannot be safely held for 48 hours prior to autonomic testing) that may confound test outcomes. Subjects will be permitted to use acute migraine or vertigo treatment up to 48 hours prior to study, but testing will take place at least 48 hours after an acute attack, as this is an inter-ictal study. Subjects will be asked to keep a headache and/or vertigo diary for the period of study.

Participant Reimbursement

10$ per hour of participation, not including time spent on travel or phone. Minimum $20 per participant; not to exceed $100. Payment will be provided in the form of a VISA gift card.