Page 90 - Migraine, the heart and the brain

Chapter 5
All control subjects were recruited among acquaintances of Dutch MFS patients, speci cally excluding family members. Patients were asked to supply the name of an acquaintance in the same age range and of the same gender as the patient who could serve as a control, before specifying the study goal. By this means, speci c selection according to headache history of controls and patients was minimised.
To investigate the speci c contribution of AR, non-MFS patients with a history of AR were recruited among patients attending the cardiothoracic surgery outpatient clinic of the Academic Medical Centre in 2008 (Amsterdam, the Netherlands). Indications for AR in this group were heterogeneous, ranging from aortic root or aortic ascendens dilatation with concomitant bicuspid aortic valve to aortic coarctation, aortic valve stenosis, severe aortic regurgitation, or systemic hypertension.
Subjects were asked to participate in a general health interview in order to reduce selection bias towards headache sufferers. The study was conducted in accordance with the revised Declaration of Helsinki (1998) and in agreement with the guidelines of the Danish and AMC Amsterdam ethics committees.
Migraine diagnosis
Danish MFS patients returned a questionnaire and then participated in a semi- structured telephone interview (10), migraine diagnosis was made according to ICHD-1 criteria (15). The Dutch participants (Marfan patients, non-Marfan patients with AR and controls) were interviewed in two stages. First three screening questions were asked. Screen positive for migraine headache was de ned as those who had at least ve moderate or severe headaches (excluding those due to hangover or sinus infection), or the participant was previously diagnosed with migraine by a physician. This rst step screener was adapted from the GEM study and has a high sensitivity but a moderate speci city (1). Those ful lling these screen-positive criteria proceeded in the same contact with a semi-structured telephone interview that focused on signs and symptoms of migraine headache and aura as outlined in ICHD-II (16). Those who screened negative did not proceed to the second stage of the interview, and were classi ed as having no migraine. An experienced headache neurologist, who was blinded to a subject’s medical les and diagnoses, evaluated all the recorded individual interview results and made the migraine diagnosis, resulting in lifetime prevalence of migraine. No speci c migraine diagnostic tool was used. A high lifetime attack frequency was de ned as having had 4 or more attacks per months any time during life.
In one-third of initially screened positive subjects, nal diagnosis was no migraine. These subjects were diagnosed with cluster headache, tension-type headache, and medication overuse headache.
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