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Does Calcified Neurocysticercosis Affect Migraine Characteristics and Treatment Responsiveness? A Case–Control Study

Kamini SharmaDepartment of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India;

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Ravi UniyalDepartment of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India;

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Ravindra Kumar GargDepartment of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India;

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Rajesh VermaDepartment of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India;

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Vimal Kumar PaliwalDepartment of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

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Hardeep Singh MalhotraDepartment of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India;

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Praveen Kumar SharmaDepartment of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India;

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Neeraj KumarDepartment of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India;

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Shweta PandeyDepartment of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India;

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Imran RizviDepartment of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India;

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ABSTRACT.

Recently, inflammation and free-radical release has been described in the surrounding brain parenchyma of seemingly inert calcified lesions of neurocysticercosis. These free radicals can induce migraine by stimulating calcitonin gene-related peptide release. This stipulated mechanism led us to hypothesize that calcified neurocysticercosis may increase migraine severity. This case–control study included patients (migraine with calcified neurocysticercosis) and control subjects (migraine without calcified neurocysticercosis) in a 1:1 ratio. Headache frequency, visual analog scale (VAS) score, and Migraine Disability Assessment (MIDAS) score were assessed at baseline and at the end of 3 months. To compare treatment responsiveness between patients and control subjects, we treated both groups identically so that difference in treatment would not confound the results. Each group comprised 78 patients. Baseline headache frequency (11.3 ± 3.3 versus 7.9 ± 3.4), VAS score (7.5 ± 1.1 versus 6.0 ± 1.2), and MIDAS score (15 ± 7.6 versus 9.6 ± 4.5) were significantly greater in patients than control subjects. Interestingly, the change from baseline to the end of 3 months in headache frequency (6.0 ± 1.7 versus 2.8 ± 1.4), VAS score (2.6 ± 0.02 versus 1.4 ± 0.01), and MIDAS score (8.3 ± 5.0 versus 3.6 ± 2.0) were significantly greater in patients than control subjects. Our study emphasizes that calcified lesions of neurocysticercosis are not inert, and cause an increase in the frequency and severity of migraine attacks. Interestingly, these patients also showed a better response to treatment with amitriptyline, possibly resulting from its anti-inflammatory action. Further studies are warranted to explore possible inflammatory mechanisms in calcified neurocysticercosis, which influences migraine physiology.

Author Notes

Address correspondence to Ravi Uniyal, Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India 226003. E-mail: ravi.sun.uniyal@gmail.com

Disclosure: R. K. G. has received royalties for writing UpToDate articles and honorarium for writing for MedLink Neurology.

Authors’ addresses: Kamini Sharma, Ravi Uniyal, Ravindra Kumar Garg, Rajesh Verma, Hardeep Singh Malhotra, Praveen Kumar Sharma, Neeraj Kumar, Shweta Pandey, and Imran Rizvi, Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India, E-mails: windblow1386@gmail.com, ravi.sun.uniyal@gmail.com, garg50@yahoo.com, drrajeshverma32@gmail.com, drhsmalhotra@gmail.com, pspgimer@gmail.com, neerajkumar@kgmcindia.edu, dr.shweta.md@gmail.com, and imranrizvi09@gmail.com. Vimal Kumar Paliwal, Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, E-mail: dr_vimalkpaliwal@rediffmail.com.

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