Migraine Disorders: Tzourio C

Kurth T, Tzourio C. · No affiliation provided · JAMA. · Pubmed #19549979 No free full text.

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Kurth T, Tzourio C, Bousser MG. · No affiliation provided · Circulation. · Pubmed #18824652 No free full text.

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Tzourio C, Bousser MG. · INSERM U360 Recherches épidémiologiques en neurologie et psychopathologie, Hôpital de la Salpêtrière, Paris. · Rev Neurol (Paris). · Pubmed #11139748 No free full text.

Abstract: In this paper we review the evidence that migraine is associated with ischemic stroke, emphasizing potential biases, factors which may influence the association, potential mechanisms, and potential public health impact. Consistency of case-control findings from several countries and supporting evidence from prospective data suggest that the association is not an artifact of study design or execution. However, it is less clear whether migraine without aura is associated with stroke or whether the association is restricted to migraine with aura. Similarly, there are few data examining the magnitude of the association among nonusers of oral contraceptives compared to those who use low estrogen oral contraceptives. Moreover, there is still no convincing evidence on the mechanisms that would be implied and on the groups of migraineurs really at risk of ischemic stroke. Despite the considerable advances in our understanding of the relationship between migraine and stroke, there are many gaps in the data needed for public health recommendations.

Tzourio C, Kittner SJ, Bousser MG, Alpérovitch A. · INSERM U360 Recherches Epidémiologiques en Neurologie et Psychopathologie, Hôpital de la Salpêtrière, Paris, France. · Cephalalgia. · Pubmed #10997773 No free full text.

Abstract: In this paper we review the evidence that migraine is associated with ischaemic stroke in young women, emphasizing potential biases, factors that may influence the association, potential mechanisms, and potential public health impact. Consistency of case-control findings from several countries and supporting evidence from prospective data suggest that the association is not an artifact of study design or execution, although, due to methodological limitations, none of the studies mentioned can be considered definite proof of the association. However, it is less clear whether migraine without aura is associated with stroke or whether the association is restricted to migraine with aura. Similarly, there are few data examining the magnitude of the association among nonusers of oral contraceptives compared with those who use low oestrogen oral contraceptives. As a consequence, there is a lack of data concurrently stratifying both by the presence vs. the absence of aura and by the use of low oestrogen oral contraceptives vs. non-use of oral contraceptives. Moreover, there is still no convincing evidence on the mechanisms that would be implied and on the groups of migraineurs really at risk of ischaemic stroke. Despite the considerable advances in our understanding of the relationship between migraine and stroke, there are many gaps in the data needed for public health recommendations.

Tzourio C, Gagnière B, El Amrani M, Alpérovitch A, Bousser MG. · INSERM U 360, Hôpital Salpêtrière, and Department of Neurology, Hôpital Lariboisière, Paris, France. · Cephalalgia. · Pubmed #14616934 No free full text.

Abstract: The relationship between migraine and blood pressure is controversial. We studied the association between migraine and blood pressure in a population-based sample of elderly patients. Participants were 1373 subjects 59-71 years of age. Lifetime migraine was diagnosed according to the International Headache Society criteria by a headache specialist. Blood pressure was measured as well as the carotid intima-media thickness (IMT) which is a good marker of the long-term exposure to high blood pressure. Migraine during life was diagnosed in 140 participants. Mean systolic blood pressure was lower in subjects with migraine than in those without headache (128 mmHg vs. 137 mmHg). There was a significant trend of decreasing frequency of migraine with increasing blood pressure and also with increasing IMT. In this study, migraine was associated with lower levels of blood pressure and with smaller values of carotid wall thickness.

Tzourio C, Gagnière B, El Amrani M, Bousser MG, Alpérovitch A. · INSERM U 360, Hôpital Salpêtrière, 75651 Paris cedex 13, France. · J Neurol Neurosurg Psychiatry. · Pubmed #12531958 links to  free full text

Abstract: OBJECTIVE: To determine the agreement between lay interviewers and experts in the diagnosis of migraine by questionnaire. SUBJECTS: A population based sample of 1188 individuals aged 64 to 73 years. METHODS: Participants who declared that they had recurrent headaches (n = 238) answered a structured questionnaire by lay interviewers with special training in migraine. A migraine expert subsequently interviewed all the headache sufferers using the same questionnaire. Migraine was defined according to the International Headache Society criteria. RESULTS: In comparison with the expert, the diagnosis derived by the lay interviewers had high values for specificity (97%) and positive predictive value (86%), and a low sensitivity (50%) and negative predictive value (57%). Agreement between the expert and the lay interviewers was low, with a kappa value of 0.36 (95% confidence interval 0.26 to 0.47). The most serious discrepancies concerned the duration of attacks, the worsening of headaches by physical activity, the presence of nausea or vomiting, and the unilaterality of headaches. As a result, the lifetime prevalence of migraine headaches was greatly underestimated by lay interviewers (6.5%) in comparison with the expert (11.1%). CONCLUSIONS: A low level of agreement between lay interviewers and a headache expert in the diagnosis of migraine headaches by structured questionnaire may result in a substantial underestimation of migraine prevalence.

Tzourio C, Benslamia L, Guillon B, Aïdi S, Bertrand M, Berthet K, Bousser MG. · INSERM U360, Service de Neurologie, Hôpital de la Salpêtrière, 75651 Paris cedex 13, France. · Neurology. · Pubmed #12177380 No free full text.

Abstract: The association between migraine and cervical artery dissection (CAD) was explored in a hospital-based case-control study. Migraine was present in 49.1% (23/47) of patients with CAD and in 21% (11/52) of patients hospitalized for a cerebral ischemic event not related to a CAD (adjusted odds ratio = 3.6; 1.5 to 8.6, p = 0.005). This result supports the hypothesis that an underlying arterial wall disease could be a predisposing condition for migraine.

Tzourio C, El Amrani M, Poirier O, Nicaud V, Bousser MG, Alpérovitch A. · INSERM U 360, Salpêtrière Hospital, Paris, France. · Neurology. · Pubmed #11376172 No free full text.

Abstract: BACKGROUND: Previous studies have described an association between migraine and endothelin, a potent vasoconstrictor. OBJECTIVE: To test the association between migraine and gene polymorphisms of the endothelin system. METHODS: A population-based study of elderly individuals (n = 1,188) in Nantes (western France) was conducted. Lifetime migraine was defined according to the International Headache Society criteria, after an interview with a headache specialist. Five polymorphisms in genes encoding endothelin 1, endothelin type A (ET(A)), and type B receptors were determined in more than 90% of the sample. RESULTS Migraine was diagnosed in 140 participants (11.9%). The ETA (-231 A/G) polymorphism was the only polymorphism significantly associated with migraine. There was a trend of decreasing prevalence of migraine with number of copies of the G allele (AA genotype: 15.7% of participants with migraine, AG: 9.7%, GG: 2.9%; p < 0.001). Carrying the G allele was associated with a sex- and age-adjusted odds ratio of 0.50 (95% CI, 0.34 to 0.74). The association was observed in both sexes and was stronger in participants with a family history of severe headaches than in those without. CONCLUSIONS: A variant of the ET(A) receptor gene modulates the risk for migraine. These results offer new insights into the pathophysiology of the vascular component of migraine.

Bousser MG, Conard J, Kittner S, de Lignières B, MacGregor EA, Massiou H, Silberstein SD, Tzourio C. · No affiliation provided · Cephalalgia. · Pubmed #10997767 No free full text.

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Tzourio C, El Amrani M, Robert L, Alpérovitch A. · INSERM U360, Hôpital de la Salpêtrière, Paris, France. · Ann Neurol. · Pubmed #10805337 No free full text.

Abstract: Migraine has been associated with diseases considered to be related to extracellular matrix disorders--in particular, cervical artery dissection. In this population-based study, we found a highly significant association between migraine and the activity of serum elastase, a metalloendopeptidase degrading specific elastin-type amino acid sequences. Such enzymes are involved in matrix degradation. This association was seen in both sexes and was stronger for migraine with aura. These findings could help in the understanding of why patients with migraine are at higher risk of stroke. Further study is needed to establish whether extracellular matrix abnormalities play a broader role in the pathophysiology of migraine.