Supplementation with which of the following may improve pediatric and adolescent migraine?
B. Coenzyme Q10
None of the above
The answer is B. Coenzyme Q10 (CoQ10) deficiency and response to supplementation were evaluated in pediatric and adolescent patients with migraine, with indication of beneficial effect of supplementation. A third of patients with frequent headaches had low CoQ10 levels and supplementation with 1-3 mg/kg/ day of CoQ10 in liquid gel capsule formulation was recommended. In a subset of patients who returned for follow-up at a mean of 3 months, the total CoQ10 level increased, while the headache frequency improved from 19.2 ± 10.0 to 12.5 ± 10.8 (p < .001) and headache disability improved. As compared to other OTC supplements, daily prophylactic treatment with CoQ10 at presumed therapeutic doses is expensive. (Hershey, Powers, Vockell, et al., Headache 2007)
Which of the following is a necessary diagnostic criterion for migraine without aura?
A. Headache attack lasting 4-72 hours
B. Unilateral location
C. Throbbing pain
D. Moderate or severe pain intensity
The answer is A. The ICHD-II diagnostic criteria for migraine without aura dictates at least five attacks of headache attack lasting 4-72 hours. At least two of the criteria: unilateral pain, pulsating pain, moderate or severe pain, or aggravation with routine physical activity are required, along with either nausea/vomiting or photophobia and phonophobia. (ICHD-II, Cephalalgia 2004)
An increase in deposition of non-heme iron is seen in which brain region associated with chronic headaches?
A. Dorsal raphe nucleus
B. Periaqueductal gray (PAG)
C. Trigeminal nucleus caudalis
D. Ventrolateral thalamus
E. All of the above
The answer is B. The periaqueductal gray (PAG) modulates trigeminovascular nociception. Welch et al. studied iron homeostasis in the midbrain of patients with episodic migraine (EM) and with chronic daily headache (CDH). High-resolution magnetic resonance techniques were used to measure non-heme iron in tissues by transverse relaxation rates. Iron homeostasis in the PAG was impaired in the endometriosis and chronic daily headache groups, correlating with frequency of headaches. The degree of iron deposition correlated with length of headache suffering. The findings that headaches can be precipitated by a lesion in the PAG and that iron deposition in the PAG correlates with headache chronicity suggest that the PAG may modulate migraine attacks by dysfunctional control of the trigeminovascular nociceptive system. (Welch, Nagesh, Aurora, et al., Headache 2001; Cutrer & Black, Headache 2006)
Which American President suffered from migraine headaches, but was not known to have had a stroke?
A. Thomas Jefferson
B. Woodrow Wilson
C. Richard Nixon
D. Millard Fillmore
E. Chester A. Arthur
The answer is A. One could argue that the burden of the presidency is a major headache trigger and all presidents should have headaches. However Thomas Jefferson, Ulysses Grant, and Harry Truman are said to have had headaches. The other listed presidents had strokes, with less clear headache symptoms. Thomas Jefferson, author of the Declaration of Independence and founder of the University of Virginia, appeared to have suffered from migraine headaches. He died at age 83 years, presumably from dehydration due to dysentery. (Jones, Cephalalagia 1999)