Herrick JA , Bustos JA , Clapham P , Garcia HH , Loeb JA , Cysticercosis Working Group in Peru , 2020. Unique characteristics of epilepsy development in neurocysticercosis. Am J Trop Med Hyg 103: 639–645.
Del Brutto OH , 2012. Neurocysticercosis: a review. Sci World J 2012: 2012.
Del Brutto OH , Del Brutto VJ , 2012. Calcified neurocysticercosis among patients with primary headache. Cephalalgia 32: 25.
Cruz ME , Cruz I , Preux PM , 1995. Headache and cysticercosis in Ecuador, South America. Headache 35: 93–97.
Del Brutto OH et al.2018. Calcified neurocysticercosis and headache in an endemic village: a case-control study nested to a population-based cohort. Am J Trop Med Hyg 99: 729.
Nash TE et al.2014. Case report: calcified neurocysticercus, perilesional edema, and histologic inflammation. Am J Trop Med Hyg 90: 318.
Del Brutto OH , Robles AM , Láinez JM , 2022. Migrainous headaches, calcified cysticercosis and breakthrough seizures. Cephalalgia Reports 5: 25158163221076464.
Russell FA , King R , Smillie SJ , Kodji X , Brain SD , 2014. Calcitonin gene-related peptide: physiology and pathophysiology. Physiol Rev 94: 1099–1142.
Arnold M , 2018. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 38: 1–211.
Garcia HH , 2018. Neurocysticercosis. Neurol Clin 36: 851–864.
Dean AG, Sullivan KM, Soe MM, 2013. OpenEpi: Open Source Epidemiologic Statistics for Public Health. www.OpenEpi.com, Available at: https://www.openepi.com/SampleSize/SSPropor.htm. Accessed January 27, 2020.
Pradhan S , Das A , Anand S , Deshmukh AR , 2019. Clinical characteristics of migraine in patients with calcified neurocysticercosis. Trans R Soc Trop Med Hyg 113: 418–423.
Sandrini G , Friberg L , Jänig W , Jensen R , Russell D , Sanchez del Rio M , Sand T , Schoenen J , Van Buchem M , Van Dijk JG , 2004. Neurophysiological tests and neuroimaging procedures in non‐acute headache: guidelines and recommendations. Eur J Neurol 11: 217–224.
Nash TE , Pretell EJ , Lescano AG , Bustos JA , Gilman RH , Gonzalez AE , Garcia HH , Cysticercosis Working Group in Peru , 2008. Perilesional brain oedema and seizure activity in patients with calcified neurocysticercosis: a prospective cohort and nested case–control study. Lancet Neurol 7: 1099–1105.
Ooi WW , Wijemanne S , Thomas CB , Quezado M , Brown CR , Nash TE , 2011. A calcified Taenia solium granuloma associated with recurrent perilesional edema causing refractory seizures: histopathological features. Am J Trop Med Hyg 85: 460.
Tajti J , Szok D , Majláth Z , Tuka B , Csáti A , Vécsei L , 2015. Migraine and neuropeptides. Neuropeptides 52: 19–30.
Hoffmann J , Baca SM , Akerman S , 2019. Neurovascular mechanisms of migraine and cluster headache. J Cereb Blood Flow Metab 39: 573–594.
Gurgel JA , Lima-Júnior RC , Rabelo CO , Pessoa BB , Brito GA , Ribeiro RA , 2013. Amitriptyline, clomipramine, and maprotiline attenuate the inflammatory response by inhibiting neutrophil migration and mast cell degranulation. Br J Psychiatry 35: 387–392.
Sadeghi H , Hajhashemi V , Minaiyan M , Movahedian A , Talebi A , 2011. A study on the mechanisms involving the anti-inflammatory effect of amitriptyline in carrageenan-induced paw edema in rats. Eur J Pharmacol 667: 396–401.
Hajhashemi V , Sadeghi H , Minaiyan M , Movahedian A , Talebi A , 2010. The role of central mechanisms in the anti-inflammatory effect of amitriptyline on carrageenan-induced paw edema in rats. Clinics (São Paulo) 65: 1183–1187.
Vismari L , Alves GJ , Muscará MN , Palermo-Neto J , 2012. A possible role to nitric oxide in the anti-inflammatory effects of amitriptyline. Immunopharmacol Immunotoxicol 34: 578–585.
Dejban P , Sahraei M , Chamanara M , Dehpour A , Rashidian A , 2021. Anti‐inflammatory effect of amitriptyline in a rat model of acetic acid‐induced colitis: the involvement of the TLR4/NF‐kB signaling pathway. Fundam Clin Pharmacol 35: 843–851.
Robinson P , Garza A , Weinstock J , Serpa JA , Goodman JC , Eckols KT , Firozgary B , Tweardy DJ , 2012. Substance P causes seizures in neurocysticercosis. PLoS Pathog 8: e1002489.
Shams PN , Plant GT , 2011. Migraine-like visual aura due to focal cerebral lesions: case series and review. Surv Ophthalmol 56: 135–161.
Singh AK et al.2018. Dynamic contrast-enhanced (DCE) MRI derived kinetic perfusion indices may help predicting seizure control in single calcified neurocysticercosis. Magn Reson Imaging 49: 55–62.
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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.
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: email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com. Vimal Kumar Paliwal, Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, E-mail: firstname.lastname@example.org.