Rajiv Gandhi University of Health Sciences s125

SYNOPSIS

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore

“Prevalence of migraine headache in patients with allergic rhinitis”

Name of the candidate: Dr.DAVID DENZIL M. ROSARIO

Guide : Dr. GEORGE J.O.PINTO

Course and Subject : M.S. (Otorhinolaryngology)

Department of Otorhinolaryngology

Father Muller Medical College

Kankanady, Mangalore – 575002.

1 SEPTEMBER-2011

RAJIV GANDHI UNIVERSITY OF HEALTH

SCIENCES,KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. NAME OF THE DR. DAVID DENZIL M.ROSARIO

CANDIDATE AND RESIDENT ADDRESS DEPARTMENT OF ENT

FR MULLER MEDICAL COLLEGE

MANGALORE- 575002 2. NAME OF THE FATHER MULLER MEDICAL

INSTITUTION COLLEGE

KANKANADY

MANGALORE- 575002 3. COURSE OF STUDY AND M.S. OTORHINOLARYNGOLOGY

SUBJECT

4. DATE OF ADMISSION TO 31 s t May 2011

COURSE

2 5. TITLE OF THE TOPIC

PREVALENCE OF MIGRAINE HEADACHE IN PATIENTS WITH ALLERGIC RHINITIS.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY

Migraine headache and allergic rhinitis are both common

disorders. Several studies have reported that migraine headache is

more common in patients with allergic rhinitis. Atopy, which is the

genetic predisposition to develop IgE antibodies to specific allergens,

may be associated with increased frequency of migraine headache.

Other studies found that migraine headache improved or were

eliminated altogether in patients that followed an elimination diet of

common food allergens.

Thus, limited data exist to support the contention that exposure

to allergens increases the frequency of migraine attacks in atopic

migraineurs.

Immunotherapy can induce tolerance to specific allergens by

altering cytokine responses of T-helper cells and through induction

3 of IgG and IgA antibodies that block the binding of IgE to mast cells.

Thereby providing an alternative approach in treatment of migraine in patients with allergic rhinitis.

Aim of this study is to determine if the allergic sensitization is associated with the prevalence, frequency, and disability of migraine headache in patients with allergic rhinitis .

6.2 REVIEW OF LITERATURE

Ku M etal ( 1 ) studied the prevalence of migraine headaches in

294 patients with allergic rhinitis. The study showed that the prevalence of migraine headache in patients with allergic rhinitis was high as compared with those without allergic rhinitis.

Martin VT ( 2 ) and his colleagues studied the association of allergy with migraine headache. The study showed lower degrees of atopy are associated with less frequent and disabling migraine headache.

Mansfield et al ( 3 ) found that 16 out of 40 migraineurs had positive skin prick tests for food allergens and 11 of these 16 patients had at least a 66% decrease in headache frequency compared with

4 baseline with avoidance of the identified foods.

Two other studies ( 4 )( 5 ) found that migraine headaches improved or were eliminated altogether in patients that followed an elimination diet of common food allergens.

Many of these studies were conducted prior to the publication of International Classification Headache Disorder-1

(ICHD-1) criteria ( 6 ) for the diagnosis of headache disorders and consequently it is unknown whether these results apply to migraine, tension-type headache or other headache disorders.

6.3 OBJECTIVES OF THE STUDY

1. Determine if the degree of allergic sensitization is associated with

the prevalence of migraine headache in individuals with allergic

rhinitis.

2. To ascertain whether these variables impact the frequency and

disability of migraine headache.

7. MATERIALS & METHODS

7.1 SOURCE OF THE DATA

The present study will be conducted in the Department of

Otorhinolaryngology, Father Muller Medical College, Mangalore.

7.2 METHODS OF COLLECTION OF DATA

The study will be conducted during the period September 2011 to

September 2013. During this period 100 patients of either gender who

will be diagnosed with allergic rhinitis clinically will be selected and

total serum IgE levels will be estimated.

We hypothize that individuals with allergic rhinitis with greater

degrees of allergic sensitization (increased IgE levels in serum)

would be more likely to experience migraine headaches and that their

attacks would be more frequent and disabling than those with lower

degrees of atopy.

Inclusion criteria:

(1) ages 18-65 years;

(2) ability to give informed consent;

(3) a confirmed diagnosis of allergic rhinitis.

Exclusion criteria:

(1) past history of secondary headache disorders such as a brain

7 aneurysm or brain tumor;

(2) significant chronic medical illnesses such as malignancy,

chronic renal failure, tuberculosis, lupus, rheumatoid

arthritis,sarcoidosis, hypereosinophilic syndrome, Wegener’s

granulomatosis, Churg-Strauss vasculitis, and polyarteritis

nodosum;

(3) pregnancy.

Procedure:

All participants will be asked if they had experienced headaches in the last year unrelated to respiratory infection, head trauma or hangover. If they give an affirmative response to the above question then a structured verbal headache interview will be administered to determine the characteristics of each headache type.

All classifiable headache diagnoses will meet strict criteria of the

International Classification of Headache Disorders-II-2004. Migraine headache will be defined as ICHD-2 diagnoses of 1.1-1.5.

Statistical analysis:

Descriptive tables will be generated showing the demographic and clinical characteristics of participants stratified by migraine status (migraineur, nonmigraineur) and migraineurs stratified by age.

8 Differences between subject groups will be assessed by chi-square

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR

INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR

OTHER HUMANS OR ANIMALS?

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM

YOUR INSTITUTION IN CASE OF 7.3? 8) yes

LIST OF REFERENCES

1) Ku M, Silverman B, Prifti N, Ying W, Persaud Y, Schneider A.

Prevalence of migraine headaches in patients with allergic

rhinitis. Ann Allergy Asthma Immunol. 2006 Aug; 97(2):226-30.

2) Martin VT, Taylor F, Gebhardt B, Tomaszewski M, Ellison JS,

Martin GV etal. Allergy and immunotherapy: are they related to

migraine headache? Headache.2011 Jan;51(1):8-20.

3) Mansfield LE,Vaughan TR,Waller SF, Haverly RW,Ting S. Food

allergy and adult migraine: Doubleblind and mediator

confirmation of an allergic etiology. Ann Allergy.1985;55:126-

9 129.

4) Monro J, Brostoff J, Carini C, Zilkha K. Food allergy in migraine.

Study of dietary exclusion and RAST. Lancet.1980;2:1-4.

5) Grant EC. Food allergies and migraine. Lancet.1979;1:966-969.

6) Headache Classification Subcommittee of the International

Headache Society. The International Classification of Headache

Disorders (2nd Edition). Cephalalgia.2004;24(Suppl. 1):24-36.

10 9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF DR. GEORGE J.O. PINTO 11.1 GUIDE Professor Dept of Otorhinolaryngology Father Muller Medical College Mangalore

11.2 SIGNATURE

11. 3 HEAD OF THE DR. GEORGE J.O. PINTO DEPARTMENT Professor & Head Dept of Otorhinolaryngology Father Muller Medical College Mangalore

11. 4 SIGNATURE

11 12. 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL

12.2 SIGNATURE