Single-fiber EMG in Migraine with or without Aura: Search for Correlations with Disability and Headache Intensity

Authors

DOI:

https://doi.org/10.20883/medical.e939

Keywords:

jitter, migraine, neuromuscular transmission, single-fiber electromyography

Abstract

Background. The idea of a neuromuscular defect in migraine relates to the emergence of mutations in the CACNA1A gene that encodes the subunit of P/Q-type calcium channels in the motor nerve terminals. This study used single-fibre electromyography (SFEMG) to investigate the potential impact of an underlying channelopathy on subclinical neuromuscular transmission at the motor end plate in different types of migraine. Additionally, we sought to validate previous findings, explore the pathophysiology, and examine any potential relationship between neuromuscular dysfunction and disease severity using the Migraine Disability Assessment Scale (MIDAS) and Visual Analog Scale (VAS).

Material and methods. We enrolled 25 healthy volunteers, 30 migraineurs with aura and 30 without aura diagnosed according to the 2018 criteria of the International Headache Society. Voluntary SFEMG was performed on the frontalis muscle. Jitter values were analysed, including the mean individual jitter values of the migraine group, the number of fibers with increased jitter, the mean Mean Consecutive Difference (MCD), and the lowest and highest jitter values, which were then compared with those of the control group. The intensity of the migraine attacks was assessed using the VAS, while disability was evaluated using the MIDAS.

Results. Our findings revealed that the highest jitter values in migraine patients were significantly higher than those observed in the control group. Furthermore, we conducted a subgroup analysis within the migraine group and found that individuals with aura had higher average MCD values compared to those without aura and the control group. Additionally, we examined the association between MIDAS and VAS scores with increased jitter values and neuromuscular transmission abnormalities, but no statistically significant correlation was found (p=0.327).

Conclusions. Our study supports the presence of motor endplate dysfunction in migraines, as indicated by previous literature, particularly in migraines with aura when compared to individuals without aura and controls. This finding aligns with the concept that this dysfunction may stem from a channelopathy associated with a genetic predisposition. Additionally, we found no clinical relationship between the neuromuscular disorder, the severity of the disease, and its disability.

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References

Russell MB, Olesen J. Increased familial risk and evidence of genetic factor in migraine. BMJ. 1995 Aug 26;311(7004):541-4. doi: 10.1136/bmj.311.7004.541. DOI: https://doi.org/10.1136/bmj.311.7004.541

Ferrari MD. Migraine. Lancet. 1998 Apr 4;351(9108):1043-51. doi: 10.1016/S0140-6736(97)11370-8. DOI: https://doi.org/10.1016/S0140-6736(97)11370-8

Ophoff RA, Terwindt GM, Vergouwe MN, van Eijk R, Oefner PJ, Hoffman SM, Lamerdin JE, Mohrenweiser HW, Bulman DE, Ferrari M, Haan J, Lindhout D, van Ommen GJ, Hofker MH, Ferrari MD, Frants RR. Familial hemiplegic migraine and episodic ataxia type-2 are caused by mutations in the Ca2+ channel gene CACNL1A4. Cell. 1996 Nov 1;87(3):543-52. doi: 10.1016/s0092-8674(00)81373-2. DOI: https://doi.org/10.1016/S0092-8674(00)81373-2

Nyholt DR, Lea RA, Goadsby PJ, Brimage PJ, Griffiths LR. Familial typical migraine: linkage to chromosome 19p13 and evidence for genetic heterogeneity. Neurology. 1998 May;50(5):1428-32. doi: 10.1212/wnl.50.5.1428. DOI: https://doi.org/10.1212/WNL.50.5.1428

Terwindt GM, Kors EE, Vein AA, Ferrari MD, van Dijk JG. Single‑fiber EMG in familial hemiplegic migraine. Neurology. 2004 Nov 23;63(10):1942-3. doi: 10.1212/01.wnl.0000144342.35011.54. DOI: https://doi.org/10.1212/01.WNL.0000144342.35011.54

Ambrosini A, de Noordhout AM, Alagona G, Dalpozzo F, Schoenen J. Impairment of neuromuscular transmission in a subgroup of migraine patients. Neurosci Lett. 1999 Dec 10;276(3):201-3. doi: 10.1016/s0304-3940(99)00820-4. DOI: https://doi.org/10.1016/S0304-3940(99)00820-4

Domitrz I, Kostera-Pruszczyk A, Kwieciñski H. A single-fibre EMG study of neuromuscular transmission in migraine patients. Cephalalgia. 2005 Oct;25(10):817-21. doi: 10.1111/j.1468-2982.2005.00961.x. DOI: https://doi.org/10.1111/j.1468-2982.2005.00961.x

Ambrosini A, Maertens de Noordhout A, Schoenen J. Neuromuscular transmission in migraine: a single-fiber EMG study in clinical subgroups. Neurology. 2001 Apr 24;56(8):1038-43. doi: 10.1212/wnl.56.8.1038. DOI: https://doi.org/10.1212/WNL.56.8.1038

Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013 Jul;33(9):629-808. doi: 10.1177/0333102413485658. DOI: https://doi.org/10.1177/0333102413485658

Bril V, Werb MR, Greene DA, Sima AA. Single-fiber electromyography in diabetic peripheral polyneuropathy. Muscle Nerve. 1996 Jan;19(1):2-9. doi: 10.1002/(SICI)1097-4598(199601)19:1<2::AID-MUS1>3.0.CO;2-J. DOI: https://doi.org/10.1002/(SICI)1097-4598(199601)19:1<2::AID-MUS1>3.0.CO;2-J

Stewart WF, Lipton RB, Dowson AJ, Sawyer J. Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology. 2001;56(6 Suppl 1):S20-8. doi: 10.1212/wnl.56.suppl_1.s20. DOI: https://doi.org/10.1212/WNL.56.suppl_1.S20

Katz J, Melzack R. Measurement of pain. Surg Clin North Am. 1999 Apr;79(2):231-52. doi: 10.1016/s0039-6109(05)70381-9. DOI: https://doi.org/10.1016/S0039-6109(05)70381-9

AAEM Quality Assurance Committee. American Association of Electrodiagnostic Medicine. Literature review of the usefulness of repetitive nerve stimulation and single fiber EMG in the electrodiagnostic evaluation of patients with suspected myasthenia gravis or Lambert-Eaton myasthenic syndrome. Muscle Nerve. 2001 Sep;24(9):1239-47. doi: 10.1002/mus.1140. DOI: https://doi.org/10.1002/mus.1140

Stålberg E, Sanders DB, Ali S, Cooray G, Leonardis L, Löseth S, Machado F, Maldonado A, Martinez-Aparicio C, Sandberg A, Smith B, Widenfalk J, Aris Kouyoumdjian J. Reference values for jitter recorded by concentric needle electrodes in healthy controls: A multicenter study. Muscle Nerve. 2016 Mar;53(3):351-62. doi: 10.1002/mus.24750. DOI: https://doi.org/10.1002/mus.24750

Kors EE, van den Maagdenberg AM, Plomp JJ, Frants RR, Ferrari MD. Calcium channel mutations and migraine. Curr Opin Neurol. 2002 Jun;15(3):311-6. doi: 10.1097/00019052-200206000-00014. DOI: https://doi.org/10.1097/00019052-200206000-00014

Losavio A, Muchnik S. Spontaneous acetylcholine release in mammalian neuromuscular junctions. Am J Physiol. 1997 Dec;273(6):C1835-41. doi: 10.1152/ajpcell.1997.273.6.C1835. DOI: https://doi.org/10.1152/ajpcell.1997.273.6.C1835

Ambrosini A, de Noordhout AM, Schoenen J. Neuromuscular transmission in migraine patients with prolonged aura. Acta Neurol Belg. 2001 Sep;101(3):166-70.

Coban A, Baslo MB, Baykan B, Tutkavul K, Orhan EK, Ertas M. Subclinical neuromuscular transmission abnormality detected by single-fibre EMG is more pronounced in cluster headache than in migraine with aura. Cephalalgia. 2007 Jul;27(7):788-92. doi: 10.1111/j.1468-2982.2007.01341.x. DOI: https://doi.org/10.1111/j.1468-2982.2007.01341.x

Ertas M, Baslo MB. Abnormal neuromuscular transmission in cluster headache. Headache. 2003 Jun;43(6):616-20. doi: 10.1046/j.1526-4610.2003.03103.x. DOI: https://doi.org/10.1046/j.1526-4610.2003.03103.x

Russell MB, Ulrich V, Gervil M, Olesen J. Migraine without aura and migraine with aura are distinct disorders. A population-based twin survey. Headache. 2002 May;42(5):332-6. doi: 10.1046/j.1526-4610.2002.02102.x. DOI: https://doi.org/10.1046/j.1526-4610.2002.02102.x

Ertaş M. KR, Varlı K.. Tek Lif EMG Tekniği. Klinik Nörofizyoloji‑EEG‑EMG Derneği Yayınları. 1995; İzmir.

Giacomini PS. Electromyography and Neuromuscular Disorders: Clinical Electrophysiologic Correlations. Mcgill J Med. 2006 Jul;9(2):173. PMCID: PMC2323522. DOI: https://doi.org/10.26443/mjm.v9i2.669

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Published

2024-06-06

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How to Cite

1.
Yetkin O, Gumusyayla S. Single-fiber EMG in Migraine with or without Aura: Search for Correlations with Disability and Headache Intensity. JMS [Internet]. 2024 Jun. 6 [cited 2024 Jul. 19];93(2):e939. Available from: https://jms.ump.edu.pl/index.php/JMS/article/view/939
Received 2023-10-17
Accepted 2024-03-24
Published 2024-06-06