Comorbidity, triggers and the use of EEG in migraine

Abstract

In this thesis the research is presented in two parts. The focus of the first part is on comorbidity and triggers in migraine. Migraine is a paroxysmal neurological disorder characterised by unilateral headaches which can be accompanied by autonomic symptoms and is triggered by internal and external factors depended on a fluctuating threshold that is genetically determined. Many patients suffer from comorbid conditions (e.g. medication overuse, depression) and triggers (internal: hormones; external: alcohol) influence attack susceptibility. Comorbidity understanding is broadened in this part by studying biopsychosocial relations with other diseases, characterising pain coping, defining substance use profiles in migraine patients (compared to the Dutch population) and the impact of SARS-CoV-2, which often involves headache.

In the second part we explore how the fluctuating brain state in migraine can be measured using EEG, bi-sinusoidal or chirp light stimulation focused on the occipital cortex and a longitudinal study design. EEG offers advantages such as high temporal resolution, ease of use and low cost. Non-linearities in visual processing are demonstrated in migraine patients, particularly increased driving responses in those with aura, and reveals substantial variability in cortical responses, highlighting migraine’s heterogeneity. This underscores the need for future home-based EEG monitoring.