1
|
Lloyd K, Harrison S, Sallis HM, Davey Smith G, Munafò MR, Wootton RE. Exploring the Bidirectional Causal Pathways Between Smoking Behaviors and Headache: A Mendelian Randomization Study. Nicotine Tob Res 2024; 26:903-912. [PMID: 37702655 PMCID: PMC11190053 DOI: 10.1093/ntr/ntad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 07/21/2023] [Accepted: 09/07/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Although observational data suggest a relationship between headache and smoking, there remain questions about causality. Smoking may increase headache risk, individuals may smoke to alleviate headaches, or smoking and headache may share common risk factors. Mendelian randomization (MR) is a method that uses genetic variants as instruments for making causal inferences about an exposure and an outcome. AIMS AND METHODS First, we conducted logistic regression of observational data in UK Biobank assessing the association between smoking behaviors (smoking status, cigarettes per day amongst daily smokers, and lifetime smoking score) on the risk of self-reported headache (in the last month and for more than 3 months). Second, we used genetic instruments for smoking behaviors and headache (identified in independent genome-wide association studies [GWAS]) to perform bidirectional MR analysis. RESULTS Observationally, there is a weak association between smoking behavior and experiencing headache, with increased cigarettes per day associated with increased headache risk. In the MR analysis, genetic liability to smoking initiation and lifetime smoking increased odds of headache in the last month but not odds of headaches lasting more than 3 months. In the opposite direction, there was weak evidence for higher genetic liability to headaches decreasing the chance of quitting. CONCLUSIONS There was weak evidence for a partially bidirectional causal relationship between smoking behaviors and headache in the last month. Given this relationship is distinct from smoking heaviness, it suggests headache and smoking may share common risk factors such as personality traits. IMPLICATIONS Using MR, this study addresses the uncertainty regarding the observed relationship between headache and smoking. There was evidence for weak causal effects of smoking initiation and lifetime smoking (but not smoking heaviness) on likelihood of experiencing headache in the last month, but not over a prolonged period of more than 3 months. Those with higher genetic liability to headaches were also less likely to successfully stop smoking. This partially bidirectional causal relationship distinct from smoking heaviness suggests that observed associations are unlikely due to biological effects of tobacco smoke exposure and may be explained by shared personality traits.
Collapse
Affiliation(s)
- Katherine Lloyd
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sean Harrison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, Bristol, UK
| | - Hannah M Sallis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - George Davey Smith
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Robyn E Wootton
- MRC Integrative Epidemiology Unit, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| |
Collapse
|
2
|
Taskiran-Sag A, Yazgi H, Ozulken K, Eroglu E. Optical coherence tomography findings in primary headache disorders: is pain duration a clinical correlate? Int J Neurosci 2024:1-7. [PMID: 38768056 DOI: 10.1080/00207454.2024.2358367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 05/11/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE Ganglion cell layer thickness (GCLT) may be used as a potential marker for central neural changes. We compared GCLT by using spectral domain optical coherence tomography (SD-OCT) in patients with primary headache disorders and healthy controls. We seek whether there was any difference between the headache groups and whether any clinical parameters correlated to GCLT. METHODS Fifty-three primary headache patients, 11 age and sex-matched healthy subjects were included in this cross-sectional study after power analysis. All subjects underwent SD-OCT. The duration of disorder, headache frequency, severity, duration of pain, presence of ocular pain, and accompanying symptoms have been collected. RESULTS Mean GCLT of the headache group was 15.7 ± 3.8 µm (mean ± standard deviation), and the control group was 17.5 ± 2.4. The difference was not statistically significant. When we compared the controls, migraine and tension-type headache patients' GCLT values, we found a significant difference (ANOVA, p = 0.001). Migraine patients had thinner GCLT compared to all non-migraine headache patients (p = 0.01). Intraocular pressure values of migraine patients and non-migraine patients were not statistically significantly different (p = 0.13). The only clinical parameter that correlated with GCLT was pain duration (r = -0.43 and p = 0.01). The patients with white matter lesions had thinner GCLT (p = 0.046). CONCLUSION Our results suggest that not long-term suffering from pain but migraine pathophysiology itself seems to affect neuroretinal tissue. Pain duration was moderately and inversely correlated to GCLT, meaning that the longer the headache, the thinner the ganglion cell layer is.
Collapse
Affiliation(s)
- Aslihan Taskiran-Sag
- Department of Neurology, Faculty of Medicine, TOBB Economics and Technology University, Ankara, Turkey
| | - Hare Yazgi
- Faculty of Medicine, TOBB Economics and Technology University, Ankara, Turkey
| | - Kemal Ozulken
- Department of Ophthalmology, Faculty of Medicine, TOBB Economics and Technology University, Ankara, Turkey
| | - Erdal Eroglu
- Department of Neurology, Faculty of Medicine, TOBB Economics and Technology University, Ankara, Turkey
| |
Collapse
|
3
|
Hantelius V, Ragnarsson O, Johannsson G, Olsson DS, Jakobsson S, Thurin E, Farahmand D, Skoglund T, Hallen T. Headache in patients with non-functioning pituitary adenoma before and after transsphenoidal surgery - a prospective study. Pituitary 2024:10.1007/s11102-024-01401-3. [PMID: 38767698 DOI: 10.1007/s11102-024-01401-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE To study the long-term effect of transsphenoidal surgery (TSS) on headache in patients with non-functioning pituitary adenoma (NFPA) and identify factors predicting headache relief following TSS. METHODS We evaluated headache in 101 consecutive patients with NFPA who underwent TSS from September 2015 to December 2021, preoperatively and 12-months post-surgery, by using the Migraine Disability Assessment (MIDAS) questionnaire. Health-related quality of life (QoL) was assessed using the EQ-5D visual analogue scale (EQ-VAS). RESULTS Of 101 patients, 27 (27%) experienced disabling preoperative headache. Among these, the median total MIDAS score improved from 60 (interquartile range (IQR): 19-140) to 10 (IQR: 0-49) (P = 0.004). Additionally, headache frequency over a 90-day period decreased from 45 (IQR: 25-83) to 6 (IQR: 3-36) days (P = 0.002), and headache intensity decreased from 5 (IQR: 4-7) to 4 (IQR: 2-7) (P = 0.016) at 12-months post-surgery. At 12 months post-surgery, 18 (67%) of 27 patients with preoperatively disabling headache showed clinically relevant improvement of their headache, 4 (15%) showed deterioration, and 5 (19%) remained unchanged. In patients with clinically relevant improvement of their headache, the EQ-VAS score improved from 50 (IQR: 30 - 7) to 80 (IQR: 65-86) (P < 0.001). Of the 74 patients with no preoperative headache, 11 (15%) developed postoperative headache. We identified no clinical factors predicting postoperative headache relief. CONCLUSION The study supports that clinically significant and long-lasting improvements of disabling headache and QoL can be achieved with TSS in a substantial number of patients with NFPA.
Collapse
Affiliation(s)
- Victor Hantelius
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Oskar Ragnarsson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Gudmundur Johannsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel S Olsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Cardiovascular, Renal and Metabolism (CVRM), Late-Stage Clinical Development, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Sofie Jakobsson
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Thurin
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dan Farahmand
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Skoglund
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tobias Hallen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
4
|
Udhawani NS, Hoover DL. Differential screen and treatment of sternocleidomastoid syndrome versus eagle syndrome: a case report. Physiother Theory Pract 2024; 40:1072-1082. [PMID: 36384424 DOI: 10.1080/09593985.2022.2144560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE Differential screening is a complex process in chronic pain conditions. There is significant uncertainty that surrounds the pathophysiology of many chronic pain syndromes that may lead to misdiagnosis and treatment failures. Such differential screening is even more challenging where there is regional overlapping from surrounding tissues. This case report chronicles the differential screening and treatment of a patient with sternocleidomastoid syndrome (SCMS) originally diagnosed as Eagle's syndrome (ES). CASE DESCRIPTION A 55-year-old woman, referred to a physical therapist (PT) by an ear, nose and throat (ENT) physician with the diagnosis of ES. The patient complained of yearlong left-sided otalgia, blurred vision, excessive lacrimation, dysphagia, hyperesthesia on the left side of the face, unilateral temporal headaches, and both left mandibular and anterior neck pain. OUTCOMES The PT examination revealed the patient did not exhibit hallmark findings for clinical confirmation of ES and instead demonstrated multiple signs consistent with SCMS. DISCUSSION Manual therapy techniques and therapeutic exercises resolved the patient's year-long chronic symptoms within 6 sessions.
Collapse
Affiliation(s)
- Nitin S Udhawani
- Physical Therapy Department, Three Rivers Health Outpatient Physical Therapy, Three Rivers, Michigan, United States
| | - Donald L Hoover
- Doctor of Physical Therapy Department, Western Michigan University, Kalamazoo, Michigan, United States
| |
Collapse
|
5
|
Alizada M, Sahin T, Sener O, Kocyigit P. Evaluation of Dermatological and Neurological Aspects of the Relationship between Rosacea and Headaches. Diagnostics (Basel) 2023; 14:23. [PMID: 38201332 PMCID: PMC10795644 DOI: 10.3390/diagnostics14010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
This study aimed to investigate the relationship between rosacea and headaches, focusing on different subtypes, as well as the associated clinical features and triggering factors. In this prospective study, 300 patients diagnosed with rosacea and 320 control subjects without rosacea or any connected mast cell activation illness were included. Patients with rosacea were assessed by a dermatologist according to the 2019 updated rosacea classification (ROSCO panel). Accordingly, patients were classified based on their predominant rosacea subtype as follows: erythematotelangiectatic (ETR), papulopustular (PPR), or phymatous (RhR). Patients experiencing headaches were assessed using the International Headache Classification. Headaches were categorized as migraine, tension-type headaches (TTHs), secondary types (STHs), and cluster-type headaches (CTHs). The ratio of headache was 30.3% in the rosacea group, which did not show a significant difference compared to the control group (30.3% vs. 25.0%, p = 0.138). In 81.3% of rosacea patients with headaches, headache onset occurred after the diagnosis of rosacea. The rate of patients with headaches was higher in the ETR group compared to the PPR and RhR groups (35.2% vs. 16.2% vs. 23.1%, p = 0.007, respectively). In terms of headache subtypes, the rates of patients with migraine and STHs were higher in the ETR group compared to the PPR and RhR groups, while the rate of patients with TTHs was higher in the RhR group. A positive correlation was found between rosacea severity and migraine severity (r = 0.284, p < 0.05). Among the triggering factors for rosacea, only sunlight was found to be associated with headaches. Lower age, female gender, and moderate to severe rosacea severity were identified as independent factors increasing the likelihood of headaches. A significant portion of rosacea patients experience headaches. Particularly, different subtypes of rosacea may be associated with various types of headaches. This study, highlighting the connection between migraine and ETR, is a pioneering work that demonstrates common pathogenic mechanisms and potential triggers.
Collapse
Affiliation(s)
- Merve Alizada
- Department of Dermatology, Mamak State Hospital, 06230 Ankara, Turkey
| | - Turgut Sahin
- Department of Neurology, Cankırı State Hospital, 18100 Çankırı, Turkey;
| | - Ozden Sener
- Department of Neurology, Ankara University Faculty of Medicine, 06100 Ankara, Turkey;
| | - Pelin Kocyigit
- Department of Dermatology, Ankara University Faculty of Medicine, 06100 Ankara, Turkey;
| |
Collapse
|
6
|
Pak RJ, Ku JB, Abd-Elsayed A. Neuromodulation for Craniofacial Pain and Headaches. Biomedicines 2023; 11:3328. [PMID: 38137549 PMCID: PMC10741888 DOI: 10.3390/biomedicines11123328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Headaches and facial pain are highly prevalent diseases but are often difficult to treat. Though there have been significant advances in medical management, many continue to suffer from refractory pain. Neuromodulation has been gaining interest for its therapeutic purposes in many chronic pain conditions, including headaches and facial pain. There are many potential targets of neuromodulation for headache and facial pain, and some have more robust evidence in favor of their use than others. Despite the need for more high-quality research, the available evidence for the use of neuromodulation in treating headaches and facial pain is promising. Considering the suffering that afflicts patients with intractable headache, neuromodulation may be an appropriate tool to improve not only pain but also disability and quality of life.
Collapse
Affiliation(s)
- Ray J. Pak
- Department of Physical Medicine and Rehabilitation, New York Medical College, Metropolitan Hospital, New York, NY 10029, USA;
| | - Jun B. Ku
- Department of Physical Medicine and Rehabilitation, New York Medical College, Metropolitan Hospital, New York, NY 10029, USA;
| | - Alaa Abd-Elsayed
- Department of Anesthesia, University of Wisconsin, Madison, WI 53792, USA
| |
Collapse
|
7
|
Alharthi TS, Hakami F, Binshalhoub FH, Kabli NA, Dalak ME, Almutairi TF, Al-Amer M, Alkhotani A. Headache Characteristics and Their Influencing Factors Among Pregnant Women in Saudi Arabia: A Survey Study. Cureus 2023; 15:e49345. [PMID: 38143645 PMCID: PMC10748932 DOI: 10.7759/cureus.49345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Background Headache disorders, particularly migraines, significantly impact public health globally. The Global Burden of Disease (GBD) report highlights migraines as the second leading cause of disability worldwide, especially among women under 50. Hormonal changes, particularly estrogen, play a role in primary headaches like migraines, and this connection becomes important during pregnancy due to physiological changes. Materials and methods A cross-sectional survey was conducted among pregnant women in Saudi Arabia to assess the characteristics of the headaches and explore their influencing factors. The study initiated the data collection process across various regions of Saudi Arabia from February 2023 to July 2023. Participants included pregnant women aged 18 or above residing in Saudi Arabia. Data were collected through an online self-administered survey with multiple-choice questions. Descriptive analysis and Pearson Chi-Square tests were performed using IBM SPSS Statistics version 25 (IBM Corp., Armonk, USA). Results A study surveyed 411 pregnant women to investigate the characteristics of headaches during pregnancy. The majority of participants were Saudi nationals 381 (92.7%) and 242 (58.9%) aged 18-30 and 357 (86.9%) resided in urban areas. Around 72 (17.5%) reported having chronic diseases. Results showed that 246 (59.9%) of pregnant women were diagnosed with headaches before pregnancy, with migraines being the most common type by 145 (35.3%). Headache frequency increased during pregnancy for 171 (41.6%) of participants, and the majority 275 (66.9%) experienced headaches lasting 0-3 hours. Nausea 219 (53.3%) and holo-cranial pain 112 (27.3%) were common accompanying symptoms. Conclusion This study provides valuable insights into the burden of headaches among pregnant women in Saudi Arabia, emphasizing the importance of improved healthcare practices and educational initiatives to effectively address this issue.
Collapse
Affiliation(s)
| | - Faisal Hakami
- Medicine, College of Medicine, Jazan University, Jazan, SAU
| | - Fahad H Binshalhoub
- Medicine and Surgery, Imam Muhammad Ibn Saud Islamic University, Riyadh, SAU
| | - Najla A Kabli
- Medicine, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | | | - Turki F Almutairi
- Medicine and Surgery, College of Medicine, Prince Sattam bin Abdualaziz University, Riyadh, SAU
| | | | | |
Collapse
|
8
|
Anandkumar D, Jakhura U, Potter K, Bhatti I. Low pressure headache and cerebral fat embolism from a sacral fracture through a Tarlov cyst: a case report. J Med Case Rep 2023; 17:444. [PMID: 37803426 PMCID: PMC10559429 DOI: 10.1186/s13256-023-04142-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/25/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Here we report the only formally documented case in the United Kingdom, to our knowledge, of a cerebral fat embolism secondary to non-iatrogenic trauma through a Tarlov cyst. This case demonstrates the pathology clearly giving an excellent opportunity to demonstrate a rarely seen pathology as well as illustrating the importance of the patient history to guiding further management. CASE PRESENTATION A middle-aged patient was admitted on the acute medical take complaining of severe headache with photophobia, having just returned after a skiing holiday. Computerised tomography scan of the head showed fat within the anterior horn of both lateral ventricles, and within the subarachnoid space. Re-discussion with the patient and subsequent MRI (Magnetic Resonance Imaging) of the spine identified the pathogenesis of her symptoms: a sacral insufficiency fracture through a Tarlov cyst, causing subarachnoid fat embolism and symptoms of a low-pressure headaches due to a dural leak. Patient was medically managed and discharged with planned follow-up. Due to the Coronavirus pandemic and resolution of the patient's symptoms, they declined further follow up imaging. CONCLUSIONS The case demonstrates a rarely seen pathology as cause of a common presenting problem, headache. Emphasizing the importance of history taking and appropriate investigations in medical cases that do not conform to the usual diagnosis.
Collapse
|
9
|
Koenig NI, McGuire JA, Shackleford VP, Bauer K. Reactivation of Herpes Simplex Virus Following Sphenopalatine Ganglion Nerve Block: Case Report and Review of the Literature. A A Pract 2023; 17:e01719. [PMID: 37870295 PMCID: PMC10609693 DOI: 10.1213/xaa.0000000000001719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 10/24/2023]
Abstract
A 36-year-old woman with no significant past medical history underwent a sphenopalatine ganglion block for treatment of a month-long migraine headache refractory to conservative treatment protocols. The headache resolved initially, but 1 day following the procedure, the headache recurred. The patient also developed an erythematous and edematous rash which cultures confirmed to be herpes simplex virus (HSV). Following several unsuccessful treatment modalities, the patient received valacyclovir, which resulted in resolution of her headache. Underlying HSV-1 infection may cause intractable migraine headache and nerve blocks may potentiate reactivation of latent HSV infection that caused the skin lesion in this case.
Collapse
Affiliation(s)
- Nicholas I. Koenig
- From the West Virginia University School of Medicine, Morgantown, West Virginia
| | - Joseph A. McGuire
- Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Violet P. Shackleford
- Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Kelsey Bauer
- Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, West Virginia
| |
Collapse
|
10
|
Finnern MT, D'Souza RS, Jin MY, Abd-Elsayed AA. Cervical Spinal Cord Stimulation for the Treatment of Headache Disorders: A Systematic Review. Neuromodulation 2023; 26:1309-1318. [PMID: 36513586 DOI: 10.1016/j.neurom.2022.10.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/02/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Chronic headache remains a major cause of disability and pain worldwide. Although the literature has extensively described pharmacologic options for headache treatment and prophylaxis, there remains a paucity of data on the efficacy of neuromodulation interventions for treatment of headache unresponsive to conventional pharmacologic therapy. The primary aim of this review was to appraise the literature for the efficacy of cervical spinal cord stimulation (cSCS) in treating any intractable chronic headache, including migraine headaches (with or without aura), cluster headache, tension headache, and other types of headaches. MATERIALS AND METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we performed a systematic review by identifying studies in PubMed, Embase (Scopus), Web of Science, and Cochrane Central Register of Controlled Trials that assessed cSCS to treat chronic headache. Data were synthesized qualitatively, with primary outcomes of headache intensity and frequency. The secondary outcome was adverse effects. RESULTS In total, 16 studies comprising 107 patients met the inclusion criteria. Findings were presented based on type of headache, which included migraine headache with or without aura, cluster headache, trigeminal neuropathy, occipital neuralgia, posttraumatic headache, cervicogenic headache, short-lasting unilateral neuralgiform headache with autonomic symptoms, and poststroke facial pain. Per the Grading of Recommendations, Assessment, Development and Evaluations criteria, there was very low-quality evidence that cSCS is associated with a decrease in migraine headache frequency, migraine headache intensity, and trigeminal neuropathy intensity. Placement for cSCS leads ranged from C1 to C4. CONCLUSIONS Our review suggests promising data from observational studies that cSCS may be helpful in decreasing frequency and intensity of chronic intractable headache. Future well-powered, randomized controlled trials are needed.
Collapse
Affiliation(s)
- Michael T Finnern
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Max Y Jin
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Alaa A Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA.
| |
Collapse
|
11
|
Baratta F, Allais G, Gnavi R, Scarinzi C, Enri LR, Rolando S, Spadea T, Costa G, Benedetto C, Mana M, Giaccone M, Mandelli A, Manzoni GC, Bussone G, Brusa P. Triptans utilization in Italian population: A real-life study in community pharmacies. PLoS One 2023; 18:e0291323. [PMID: 37682959 PMCID: PMC10490971 DOI: 10.1371/journal.pone.0291323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
The term Headache Disorders (HD) refers to a number of nervous system pathologies characterised by recurrent headaches. Despite the serious impact HD have on the health system, society, and the economy, these are an underestimated, underdiagnosed, and, hence, undertreated phenomenon. Triptans are the first-line therapy for the acute treatment of moderate to severe migraine but their utilization is still inadequate, perhaps also because in Italy no triptan can be bought without a medical prescription. In this article, the data from a 2016-2017 study has been further analysed with the aim of evaluating any associations between the use of triptans and the other series of variables identified in the questionnaire. This further analysis has been connected to the role that community pharmacies could play on this issue. The questionnaire was administered to 4,424 pharmacy users by 610 purposely trained pharmacists working in 514 pharmacies. The survey was carried out in 19 of the 20 Italian regions. The data shows that only 25% of patients suffering from HDs are prescribed triptans. Older patients, those with definite migraines, and those with a chronic disorder resort more frequently to this class of pharmaceuticals, as do those patients in care at a specialist headache centre. The multivariable analysis also confirmed these results. Our study, which performed a direct detection, in real life, on patients requesting pharmacological treatment for a migraine headache, therefore confirmed the need to investigate the reasons behind the low use and prescription of triptans in the Italian population. Moreover, any future studies should take advantage of community pharmacies, plan actions that would allow a series of evaluations over time of the requirements of migraineurs, and establish a process to put these patients under the care of the pharmacy to ensure adherence to therapy.
Collapse
Affiliation(s)
- Francesca Baratta
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Gianni Allais
- Department of Surgical Sciences, Women’s Headache Center, University of Turin, Turin, Italy
- FI.CEF Onlus, Italian Headache Foundation, Milan, Italy
| | - Roberto Gnavi
- Epidemiology Unit, ASL TO3, Grugliasco (Turin), Italy
| | | | | | - Sara Rolando
- Department of Surgical Sciences, Women’s Headache Center, University of Turin, Turin, Italy
| | - Teresa Spadea
- Epidemiology Unit, ASL TO3, Grugliasco (Turin), Italy
| | | | - Chiara Benedetto
- Department of Surgical Sciences, Women’s Headache Center, University of Turin, Turin, Italy
| | | | - Mario Giaccone
- Order of Pharmacists of Turin, Turin, Italy
- FOFI, Federation of the Orders of Italian Pharmacists, Rome, Italy
| | - Andrea Mandelli
- FOFI, Federation of the Orders of Italian Pharmacists, Rome, Italy
| | | | | | - Paola Brusa
- Department of Drug Science and Technology, University of Turin, Turin, Italy
- Order of Pharmacists of Turin, Turin, Italy
| |
Collapse
|
12
|
Pleș H, Florian IA, Timis TL, Covache-Busuioc RA, Glavan LA, Dumitrascu DI, Popa AA, Bordeianu A, Ciurea AV. Migraine: Advances in the Pathogenesis and Treatment. Neurol Int 2023; 15:1052-1105. [PMID: 37755358 PMCID: PMC10535528 DOI: 10.3390/neurolint15030067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023] Open
Abstract
This article presents a comprehensive review on migraine, a prevalent neurological disorder characterized by chronic headaches, by focusing on their pathogenesis and treatment advances. By examining molecular markers and leveraging imaging techniques, the research identifies key mechanisms and triggers in migraine pathology, thereby improving our understanding of its pathophysiology. Special emphasis is given to the role of calcitonin gene-related peptide (CGRP) in migraine development. CGRP not only contributes to symptoms but also represents a promising therapeutic target, with inhibitors showing effectiveness in migraine management. The article further explores traditional medical treatments, scrutinizing the mechanisms, benefits, and limitations of commonly prescribed medications. This provides a segue into an analysis of emerging therapeutic strategies and their potential to enhance migraine management. Finally, the paper delves into neuromodulation as an innovative treatment modality. Clinical studies indicating its effectiveness in migraine management are reviewed, and the advantages and limitations of this technique are discussed. In summary, the article aims to enhance the understanding of migraine pathogenesis and present novel therapeutic possibilities that could revolutionize patient care.
Collapse
Affiliation(s)
- Horia Pleș
- Department of Neurosurgery, Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Ioan-Alexandru Florian
- Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Teodora-Larisa Timis
- Department of Physiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Razvan-Adrian Covache-Busuioc
- Neurosurgery Department, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (R.-A.C.-B.); (L.-A.G.); (D.-I.D.); (A.A.P.); (A.B.); (A.V.C.)
| | - Luca-Andrei Glavan
- Neurosurgery Department, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (R.-A.C.-B.); (L.-A.G.); (D.-I.D.); (A.A.P.); (A.B.); (A.V.C.)
| | - David-Ioan Dumitrascu
- Neurosurgery Department, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (R.-A.C.-B.); (L.-A.G.); (D.-I.D.); (A.A.P.); (A.B.); (A.V.C.)
| | - Andrei Adrian Popa
- Neurosurgery Department, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (R.-A.C.-B.); (L.-A.G.); (D.-I.D.); (A.A.P.); (A.B.); (A.V.C.)
| | - Andrei Bordeianu
- Neurosurgery Department, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (R.-A.C.-B.); (L.-A.G.); (D.-I.D.); (A.A.P.); (A.B.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Neurosurgery Department, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (R.-A.C.-B.); (L.-A.G.); (D.-I.D.); (A.A.P.); (A.B.); (A.V.C.)
| |
Collapse
|
13
|
A machine learning approach to support triaging of primary versus secondary headache patients using complete blood count. PLoS One 2023; 18:e0282237. [PMID: 36877693 PMCID: PMC9987784 DOI: 10.1371/journal.pone.0282237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/09/2023] [Indexed: 03/07/2023] Open
Abstract
Headaches account for up to 4.5% of emergency department visits, where they present a significant diagnostic challenge. While primary headaches are benign, secondary headaches can be life-threatening. It is essential to rapidly differentiate between primary and secondary headaches as the latter require immediate diagnostic work-up. Current assessment relies on subjective measures; time constraints can result in overuse of diagnostic neuroimaging, prolonging diagnosis, and adding to economic burden. There is therefore an unmet need for a time- and cost-efficient, quantitative triaging tool to guide further diagnostic testing. Routine blood tests may provide important diagnostic and prognostic biomarkers indicating underlying headache causes. In this retrospective study (approved by the UK Medicines and Healthcare products Regulatory Agency Independent Scientific Advisory Committee for Clinical Practice Research Datalink (CPRD) research [20_000173]), UK CPRD real-world data from patients (n = 121,241) presenting with headache from 1993-2021 were used to generate a predictive model based on a machine learning (ML) approach for primary versus secondary headaches. A ML-based predictive model was constructed using two different methods (logistic regression and random forest) and the following predictors were evaluated: ten standard measurements of complete blood count (CBC) test, 19 ratios of the ten CBC test parameters, and patient demographic and clinical characteristics. The model's predictive performance was assessed using a set of cross-validated model performance metrics. The final predictive model showed modest predictive accuracy using the random forest method (balanced accuracy: 0.7405). The sensitivity, specificity, false negative rate (incorrect prediction of secondary headache as primary headache), and false positive rate (incorrect prediction of primary headache as secondary headache) were 58%, 90%, 10%, and 42%, respectively. The ML-based prediction model developed could provide a useful time- and cost-effective quantitative clinical tool to facilitate the triaging of patients presenting to the clinic with headache.
Collapse
|
14
|
Surbakti KP, Batubara CA, Mahendrayana E. Hematologic Differences Between Migraineurs and Tension-Type Headache Patients. Med Arch 2023; 77:482-488. [PMID: 38313114 PMCID: PMC10834054 DOI: 10.5455/medarh.2023.77.482-488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/24/2023] [Indexed: 02/06/2024] Open
Abstract
Background Headaches are among the most common complaints observed in neurology and medicine, notably migraines and tension-type headaches (TTH). Objective The purpose of this study was to compare hematologic parameters comprised hemoglobin, hematocrit, platelets, leukocytes, neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) between migraineurs and tension-type headache patients. Methods This cross-sectional study included 23 migraineurs and 23 TTH-diagnosed patients, in accordance with the International Classification of Headache Disorders-3 beta version (ICHD-3-beta). The patients underwent hematological laboratory testing, which included assessments of their serum levels of hemoglobin, hematocrit, platelets, leucocytes as well as neutrophils, lymphocytes and monocytes. Results There were significant differences in the mean platelets serum levels between migraineurs and TTH patients, with migraineurs having 355.3 x 103/μl (SD±47.4 x 103/μl) and TTH patients having 282.0 x 103 /μl (SD± 44.2 x 103) /μl, respectively (p = 0.001). However, there were no differences in the mean level of hemoglobin, hematocrit and leukocytes between the two groups. There was also a significant difference in PLR between migraineurs and TTH patients, with a ratio of 138.1 (SD±36.0) in migraineurs and 110.2 (SD±21.9) in TTH patients (p =0.003), but no differences in NLR or LMR. Conclusion The mean serum levels of platelets and platelets-to-lymphocyte ratio of migraineurs were significantly higher than TTH patients. However, there were no differences in the mean levels of hemoglobin, hematocrit, leukocytes, NLR and LMR between the two groups.
Collapse
Affiliation(s)
| | - Chairil Amin Batubara
- Neurology Department, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Eka Mahendrayana
- Resident of Neurology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| |
Collapse
|
15
|
Nicholas M, Erridge S, Bapir L, Pillai M, Dalavaye N, Holvey C, Coomber R, Rucker JJ, Weatherall MW, Sodergren MH. UK medical cannabis registry: assessment of clinical outcomes in patients with headache disorders. Expert Rev Neurother 2023; 23:85-96. [PMID: 36722292 DOI: 10.1080/14737175.2023.2174017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Headache disorders are a common cause of disability and reduced health-related quality of life globally. Growing evidence supports the use of cannabis-based medicinal products (CBMPs) for chronic pain; however, a paucity of research specifically focuses on CBMPs' efficacy and safety in headache disorders. This study aims to assess changes in validated patient-reported outcome measures (PROMs) in patients with headaches prescribed CBMPs and investigate the clinical safety in this population. METHODS A case series of the UK Medical Cannabis Registry was conducted. Primary outcomes were changes from baseline in PROMs (Headache Impact Test-6 (HIT-6), Migraine Disability Assessment (MIDAS), EQ-5D-5L, Generalized Anxiety Disorder-7 (GAD-7) questionnaire and Single-Item Sleep Quality Scale (SQS)) at 1-, 3-, and 6-months follow-up. P-values <0.050 were deemed statistically significant. RESULTS Ninety-seven patients were identified for inclusion. Improvements in HIT-6, MIDAS, EQ-5D-5L and SQS were observed at 1-, 3-, and 6-months (p < 0.005) follow-up. GAD-7 improved at 1- and 3-months (p < 0.050). Seventeen (17.5%) patients experienced a total of 113 (116.5%) adverse events. CONCLUSION Improvements in headache/migraine-specific PROMs and general health-related quality of life were associated with the initiation of CBMPs in patients with headache disorders. Cautious interpretation of results is necessary, and randomized control trials are required to ascertain causality.
Collapse
Affiliation(s)
- Martha Nicholas
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Simon Erridge
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Lara Bapir
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Manaswini Pillai
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nishaanth Dalavaye
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Carl Holvey
- Department of Medicine, Sapphire Medical Clinics, London, UK
| | - Ross Coomber
- Department of Medicine, Sapphire Medical Clinics, London, UK.,Department of Trauma and Orthopaedics, St. George's Hospital NHS Trust, London, UK
| | - James J Rucker
- Department of Medicine, Sapphire Medical Clinics, London, UK.,Department of Psychological Medicine, Kings College London, London, UK.,Centre for Affective Disorders, South London & Maudsley NHS Foundation Trust, London, UK
| | - Mark W Weatherall
- Department of Medicine, Sapphire Medical Clinics, London, UK.,Department of Neurology, Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - Mikael H Sodergren
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Medicine, Sapphire Medical Clinics, London, UK
| |
Collapse
|
16
|
Spekker E, Körtési T, Vécsei L. TRP Channels: Recent Development in Translational Research and Potential Therapeutic Targets in Migraine. Int J Mol Sci 2022; 24:ijms24010700. [PMID: 36614146 PMCID: PMC9820749 DOI: 10.3390/ijms24010700] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Migraine is a chronic neurological disorder that affects approximately 12% of the population. The cause of migraine headaches is not yet known, however, when the trigeminal system is activated, neuropeptides such as calcitonin gene-related peptide (CGRP) and substance P (SP) are released, which cause neurogenic inflammation and sensitization. Advances in the understanding of migraine pathophysiology have identified new potential pharmacological targets. In recent years, transient receptor potential (TRP) channels have been the focus of attention in the pathophysiology of various pain disorders, including primary headaches. Genetic and pharmacological data suggest the role of TRP channels in pain sensation and the activation and sensitization of dural afferents. In addition, TRP channels are widely expressed in the trigeminal system and brain regions which are associated with the pathophysiology of migraine and furthermore, co-localize several neuropeptides that are implicated in the development of migraine attacks. Moreover, there are several migraine trigger agents known to activate TRP channels. Based on these, TRP channels have an essential role in migraine pain and associated symptoms, such as hyperalgesia and allodynia. In this review, we discuss the role of the certain TRP channels in migraine pathophysiology and their therapeutic applicability.
Collapse
Affiliation(s)
- Eleonóra Spekker
- ELKH-SZTE Neuroscience Research Group, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
| | - Tamás Körtési
- ELKH-SZTE Neuroscience Research Group, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
- Faculty of Health Sciences and Social Studies, University of Szeged, Temesvári krt. 31, H-6726 Szeged, Hungary
| | - László Vécsei
- ELKH-SZTE Neuroscience Research Group, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
- Correspondence: ; Tel.: +36-62-545351; Fax: +36-62-545597
| |
Collapse
|
17
|
Tasnim S, Wilson SG, Walsh JP, Nyholt DR. Cross-Trait Genetic Analyses Indicate Pleiotropy and Complex Causal Relationships between Headache and Thyroid Function Traits. Genes (Basel) 2022; 14:16. [PMID: 36672757 PMCID: PMC9858525 DOI: 10.3390/genes14010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/17/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Epidemiological studies have reported a comorbid relationship between headache and thyroid traits; however, little is known about the shared genetics and causality that contributes to this association. We investigated the genetic overlap and associations between headache and thyroid function traits using genome-wide association study (GWAS) data. We found a significant genetic correlation (rg) with headache and hypothyroidism (rg = 0.09, p = 2.00 × 10−4), free thyroxine (fT4) (rg = 0.08, p = 5.50 × 10−3), and hyperthyroidism (rg = −0.14, p = 1.80 × 10−3), a near significant genetic correlation with secondary hypothyroidism (rg = 0.20, p = 5.24 × 10−2), but not with thyroid stimulating hormone (TSH). Pairwise-GWAS analysis revealed six, 14, four and five shared (pleiotropic) loci with headache and hypothyroidism, hyperthyroidism, secondary hypothyroidism, and fT4, respectively. Cross-trait GWAS meta-analysis identified novel genome-wide significant loci for headache: five with hypothyroidism, three with secondary hypothyroidism, 12 with TSH, and nine with fT4. Of the genes at these loci, six (FAF1, TMX2-CTNND1, AARSD1, PLCD3, ZNF652, and C20orf203; headache-TSH) and six (HMGB1P45, RPL30P1, ZNF462, TMX2-CTNND1, ITPK1, SECISBP2L; headache-fT4) were significant in our gene-based analysis (pFisher’s combined p-value < 2.09 × 10−6). Our causal analysis suggested a positive causal relationship between headache and secondary hypothyroidism (p = 3.64 × 10−4). The results also suggest a positive causal relationship between hypothyroidism and headache (p = 2.45 × 10−3) and a negative causal relationship between hyperthyroidism and headache (p = 1.16 × 10−13). These findings suggest a strong evidence base for a genetic correlation and complex causal relationships between headache and thyroid traits.
Collapse
Affiliation(s)
- Sana Tasnim
- Statistical and Genomic Epidemiology Laboratory, School of Biomedical Sciences, Faculty of Health, and Centre for Genomics and Personalised Health, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Scott G. Wilson
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
- School of Biomedical Sciences, University of Western Australia, Nedlands, WA 6009, Australia
- Department of Twin Research and Genetic Epidemiology, King’s College London, London SE1 7EH, UK
| | - John P. Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
- Medical School, University of Western Australia, Nedlands, WA 6009, Australia
| | - Dale R. Nyholt
- Statistical and Genomic Epidemiology Laboratory, School of Biomedical Sciences, Faculty of Health, and Centre for Genomics and Personalised Health, Queensland University of Technology, Brisbane, QLD 4059, Australia
| |
Collapse
|
18
|
Vgontzas A, Loder E. Addressing inequities in headache care by embedding services in a community health center in Boston, MA. Headache 2022; 62:1416-1418. [PMID: 36322009 DOI: 10.1111/head.14408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 12/14/2022]
Abstract
There is a critical need to diagnose and treat headache disorders in primary care settings. This is especially true for those who face systemic barriers to healthcare access due to racism or poverty. In order to target those at higher risk of disability associated with neurologic disease in our healthcare system, we embedded a specialized headache and neurology clinic within the Brigham and Women's Hospital Southern Jamaica Plain Community Health Center in Boston, MA. The goal was to create a sustainable, integrated clinic consistent with the CHC's racial justice mission, with an emphasis on equitable care, awareness of structural barriers to care, improved communication with primary care and inclusion of trainees as important members of a healthcare team. In its' first year, the clinic had over 400 patient visits, with a near-perfect rate of completion of consults. In addition to improved access to tertiary care headache services, successes have included improving continuity of care, cultivating a model of shared care with primary care practitioners and stimulating interest in headache medicine among staff and trainees. Challenges have included the use of staff time to complete prior authorizations, and the need to find or develop Spanish-language and culturally appropriate patient educational resources. By providing care within the patient's medical home, the headache specialist gains a deeper appreciation of a patient's social determinants of health and can readily access resources to navigate barriers. The personal and professional fulfillment that headache specialists may experience while doing this important work could help protect against burnout. Sustainability depends on ensuring equitable provider reimbursement; departmental and institutional support is essential. We believe this clinic can serve as a model for specialists throughout the United States who wish to improve the delivery of care to patient populations who face access barriers.
Collapse
Affiliation(s)
- Angeliki Vgontzas
- Graham Headache Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth Loder
- Graham Headache Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
19
|
Diagnosis and management of headache disorders in osteopathic practice: A qualitative study. INT J OSTEOPATH MED 2022. [DOI: 10.1016/j.ijosm.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
20
|
Atherton K, Forshaw MJ, Kidd TM. Readability of online health information pertaining to migraine and headache in the UK. Br J Pain 2022; 17:117-125. [PMID: 37057254 PMCID: PMC10088424 DOI: 10.1177/20494637221134461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An estimated 46% of the worldwide adult population live with an active headache disorder, and it is thought that there is a proportion of headache and migraine sufferers who do not attend for medical care, instead choosing to manage their symptoms at home. The internet continues to act as a source of online health information for self-management, however, it is important that this information can be understood by the user. Research indicates that most health information online is written at a level too difficult for much of the UK population to understand. The aim of this study was to investigate the readability of online health information pertaining to headache and migraine for a UK-based internet user accessing the top four search engines. Searches for ‘headache’ and ‘migraine’ were performed on each search engine and results from the first page were selected for analysis. Five validated readability tests were used to analyse readability; Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning Fog Index, Coleman-Liau Index and Simple Measure of Gobbledygook Index. We found that the majority of online health information about migraine and headache is too difficult for the UK adult population to read. Findings highlight work is required to ensure that information from a wider variety of sources is easier to comprehend for much of the population in order for individuals to make informed decisions about health seeking and self-management of headache and migraine. Health information providers should weave readability analysis into their content design process, incorporating shorter sentences and simpler words in their description of conditions and treatment.
Collapse
Affiliation(s)
- Kate Atherton
- School of Psychology, Liverpool John Moores University, UK
| | | | - Tara M. Kidd
- School of Psychology, Liverpool John Moores University, UK
| |
Collapse
|
21
|
Abstract
In light of the multiple pharmacologic alternatives for migraine management, the adverse effects associated with different treatment regimens, and their varying efficacy, it is vital to undertake ongoing evaluations and seek a tailored therapeutic strategy. This case report describes two patients who presented with classic migraine headaches, with the first responding to both abortive and prophylactic migraine medications and the second, with status migrainosus-like presentation, responding to the newer antimigraine agents. We also examined current pharmacological therapeutic options and existing recommendations, analyzing their strengths and weaknesses. This case review exemplifies how treatment in the last 10 years and success in medications used for abortive and prophylactic therapy are evolving from the older agents to newer agents like the recently approved calcitonin gene receptor protein monoclonal antibody inhibitors.
Collapse
|
22
|
Putera RM, Sani AF. A rare case of recurrent headache during exercise due to severe intracranial atherosclerotic stenosis. J Neurosci Rural Pract 2022; 13:775-777. [PMID: 36743748 PMCID: PMC9894330 DOI: 10.25259/jnrp-2022-5-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 02/07/2023] Open
Abstract
Intracranial atherosclerotic stenosis (ICAS) can cause ischemic stroke, up to 30-50% stroke in Asian population. However, recurrent exercise-induced headache due to ICAS has not been reported. We present a case of a patient 60-year-old male suffering from recurrent headache during exercise due to severe ICAS. The headache occurred after 5 minutes of running, appeared shortly after every running, and resolved at rest. Head magnetic resonance angiography showed moderate bilateral stenosis at middle cerebral artery (MCA), and cerebral catheter angiography confirmed 70% stenosis of the left MCA and 20% stenosis of the right MCA, with robust antegrade flow and good collaterals which explained why there was no neurological deficit. After treated with best medical therapy, including dual antiplatelet, statin therapy, and risk factor modification, for 90 days, he was capable of running for 20 min without headache.
Collapse
Affiliation(s)
- Rudolph Muliawan Putera
- Department of Neurology, Airlangga Faculty of Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Achmad Firdaus Sani
- Department of Neurology, Airlangga Faculty of Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia
| |
Collapse
|
23
|
Ong-Artborirak P, Boonchieng W, Juntarawijit Y, Juntarawijit C. Potential Effects on Mental Health Status Associated with Occupational Exposure to Pesticides among Thai Farmers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9654. [PMID: 35955007 PMCID: PMC9367823 DOI: 10.3390/ijerph19159654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Pesticide-related mental health issues in Thailand, an upper-middle-income country, are not well known. This study aimed to investigate the association between the history of occupational exposure to pesticides and the mental health of Thai farmers. A cross-sectional study was carried out in the areas around Chiang Mai, a large city in Northern Thailand, between June 2020 and January 2021. A total of 6974 farmers from six districts were interviewed to determine whether they regularly experienced symptoms related to mental health by the Self-Reporting Questionnaire (SRQ-20) as well as their lifetime history of agricultural pesticide exposure from 31 active ingredients and five functional categories: insecticides, herbicides, fungicides, rodenticides, and molluscicides. The cut-off of 6 was used to evaluate probable mental disorder. Most of the farmers under investigation were men (53.8%), with a mean age of 55.2 (11.7) years, and were involved mainly in the planting of rice, fruit, and vegetables. About 86.7% reported having used pesticides on their crops at some point in their lives-mostly glyphosate, paraquat, 2,4-D, methomyl, and carbofuran. All functional groups, as well as pesticide classes like organochlorines, organophosphates, and carbamates, were significantly associated with a higher risk of probable mental disorder based on exposure duration, frequency, personal protective equipment usage, and hygienic behavior. In a model with multiple pesticides, there was an association between mental disorder and exposure to endosulfan (AOR = 2.27, 95%CI = 1.26-4.08) and methyl parathion (AOR = 2.26, 95%CI = 1.26-4.06). Having previously reported pesticide poisoning symptoms was related to mental disorder (AOR = 7.97, 95%CI = 5.16-12.31), the findings provided evidence of pesticide exposure posing a risk to farmers' mental health, particularly long-term and high-intensity exposure.
Collapse
Affiliation(s)
- Parichat Ong-Artborirak
- Faculty of Public Health, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Excellence in Community Health Informatics, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Waraporn Boonchieng
- Faculty of Public Health, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Excellence in Community Health Informatics, Chiang Mai University, Chiang Mai 50200, Thailand
| | | | - Chudchawal Juntarawijit
- Faculty of Agriculture Natural Resources and Environment, Naresuan University, Phitsanulok 65000, Thailand
| |
Collapse
|
24
|
Chhabra M, Vidyasagar K, Gudi SK, Sharma J, Sharma R, Rashid M. Efficacy and safety of saroglitazar for the management of dyslipidemia: A systematic review and meta-analysis of interventional studies. PLoS One 2022; 17:e0269531. [PMID: 35776741 PMCID: PMC9249226 DOI: 10.1371/journal.pone.0269531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background and objective
Saroglitazar is a newer antidiabetic agent approved to manage dyslipidemia. The objective is tevaluate the efficacy and safety profiles of saroglitazar in patients with dyslipidemia.
Methods
A systematic search was conducted using PubMed, Cochrane Library, Scopus, and Google Scholar from the inception until January 2022. Interventional studies comparing the anti-hyperlipidaemic effect and safety of saroglitazar with or without a control group(s) were included. The efficacy of saroglitazar was assessed concerning its effect on total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL)-cholesterol, triglycerides, fasting plasma glucose, and non-HDL cholesterol. The effects on serum creatinine levels, bodyweight reduction, alanine aminotransferase and aspartate aminotransferase were considered to be safety endpoint.The Cochrane risk of bias assessment tool was used to assess the methodological quality of the included studies.
Results
A total of six studies with 581 adults with a mean age ranging from 40.2 to 62.6 years were included in this study. A significant decrease in low-density lipoprotein cholesterol was observed with saroglitazar 4 mg therapy compared to saroglitazar 2 mg [standardized mean difference (SMD): −0.23 mg/dL, 95% CI: −0.47 to 0.00; p = 0.05; 2 studies], and control [SMD: −0.36 mg/dL, 95% CI −0.59 to -0.12; p = 0.0026; 3 studies]. Also, a significant decrease in the total cholesterol was observed with saroglitazar 4 mg therapy compared to saroglitazar 2 mg [SMD − 0.28 mg/dL, 95% CI: − 0.52 to -0.04; p < 0.01; 2 studies], and control [SMD − 0.49 mg/dL, 95% CI: − 0.72 to -0.26; p < 0.0001; 3 studies]. Saroglitazar was not associated with adverse effects such as increase in serum creatinine levels, alanine aminotransferase and aspartate aminotransferase and bodyweight reduction.
Conclusion
Saroglitazar appeared to be an effective and safer therapeutic option for improving dyslipidemia in patients. However, comparative studies of saroglitazar with the other pharmacological agents are warranted.
Collapse
Affiliation(s)
- Manik Chhabra
- Department of Pharmacy Practice, Indo-Soviet Friendship College of Pharmacy, Moga, Punjab, India
- Rady Faculty of Health Sciences, Department of Pharmacology and Therapeutics, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Kota Vidyasagar
- Department of Pharmacy, University College of Pharmaceutical Sciences, Kakatiya University, Warangal, Telangana, India
| | - Sai Krishna Gudi
- Rady Faculty of Health Sciences, College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada
| | - Jatin Sharma
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rishabh Sharma
- Department of Pharmacy Practice, Indo-Soviet Friendship College of Pharmacy, Moga, Punjab, India
| | - Muhammed Rashid
- Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, BG Nagara, Karnataka, India
- * E-mail:
| |
Collapse
|
25
|
Design and evaluation of sustained release mucoadhesive film of sumatriptan succinate containing grafted co-polymer as the platform. Saudi Pharm J 2022; 30:1527-1537. [DOI: 10.1016/j.jsps.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/23/2022] [Indexed: 11/23/2022] Open
|
26
|
Huzzey-Cunningham E, McWilliam M, Mahtani V, Bridge H, Breukel C, Schytz HW, Draper-Rodi J. Study to assess existing knowledge of headache disorders among registered osteopaths practising in the UK: A cross-sectional survey. INT J OSTEOPATH MED 2022. [DOI: 10.1016/j.ijosm.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
27
|
Yuliana Y, Tandrasasmita OM, Tjandrawinata RR. Anti-inflammatory Effect of Predimenol, A Bioactive Extract from Phaleria macrocarpa, through the Suppression of NF-κB and COX-2. RECENT ADVANCES IN INFLAMMATION & ALLERGY DRUG DISCOVERY 2022; 15:RAIAD-EPUB-120287. [PMID: 35043776 DOI: 10.2174/2772270816666220119122259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/09/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Inflammation is the response to the reaction of any type of bodily injury by elevating cellular metabolism and releasing soluble mediators. It is also a contributing factor of pain. Predimenol, which has previously been known as DLBS1442, is a bioactive extract from Phaleria macrocarpa (Scheff.) Boerl (Thymelaceae). It can be an alternative treatment for pain relief, especially for long-term use. OBJECTIVE The objective of this study is to evaluate the anti-inflammatory activities of predimenol through the evaluation of several parameters involved in the inflammatory pathway. METHODS Cyclooxygenase 2 (COX-2), inducible nitric oxide synthase (iNOS), tumor necrosis factor- (TNF-), interleukin-1β (IL-1β), interleukin-2 (IL-2), interleukin-6 (IL-6), and nuclear factor B (NF-B) were observed after 24 h exposure of predimenol (0-180 µg/mL) to lipopolysaccharides (LPS)-activated RAW 264.7 cell. The inflammatory markers were measured using nitric oxide (NO) assay and enzyme-linked immunosorbent assay (ELISA) for COX-2 inhibitor assay. The gene expressions of TNF-α, IL-1β, IL-2 and IL-6 were quantified using the polymerase chain reaction (PCR) method. Western blotting was applied to detect phosphorylated IB kinase (IKK) protein to confirm the activation of NF-κB. RESULTS Our study showed a similar mechanism with most non-steroidal anti-inflammatory drugs (NSAIDs). Predimenol consistently downregulated the expression of iNOS and inhibited COX-2 activity. Moreover, predimenol significantly inhibited the LPS-induced production of NO, TNF-α, IL-1β, IL-2 and IL-6. Down-regulation of these markers was suggested due to the reduction of NF-κB transcription level and activation by predimenol. CONCLUSION Predimenol exhibits anti-inflammatory activities through NF-kB inactivation-mediated COX-2 suppression, which may suggest that predimenol is a potential analgesic and anti-inflammatory agent.
Collapse
Affiliation(s)
- Yurike Yuliana
- Section of Molecular Pharmacology; Research Innovation and Invention, Dexa Laboratories of Biomolecular Sciences, Dexa Medica, Indonesia
| | - Olivia M Tandrasasmita
- Section of Molecular Pharmacology; Research Innovation and Invention, Dexa Laboratories of Biomolecular Sciences, Dexa Medica, Indonesia
| | - Raymond R Tjandrawinata
- Section of Molecular Pharmacology; Research Innovation and Invention, Dexa Laboratories of Biomolecular Sciences, Dexa Medica, Indonesia | Faculty of Biotechnology, Atma Jaya Catholic University of Indonesia, Indonesia
| |
Collapse
|
28
|
Ngarka L, Siewe Fodjo JN, Aly E, Masocha W, Njamnshi AK. The Interplay Between Neuroinfections, the Immune System and Neurological Disorders: A Focus on Africa. Front Immunol 2022; 12:803475. [PMID: 35095888 PMCID: PMC8792387 DOI: 10.3389/fimmu.2021.803475] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/13/2021] [Indexed: 12/31/2022] Open
Abstract
Neurological disorders related to neuroinfections are highly prevalent in Sub-Saharan Africa (SSA), constituting a major cause of disability and economic burden for patients and society. These include epilepsy, dementia, motor neuron diseases, headache disorders, sleep disorders, and peripheral neuropathy. The highest prevalence of human immunodeficiency virus (HIV) is in SSA. Consequently, there is a high prevalence of neurological disorders associated with HIV infection such as HIV-associated neurocognitive disorders, motor disorders, chronic headaches, and peripheral neuropathy in the region. The pathogenesis of these neurological disorders involves the direct role of the virus, some antiretroviral treatments, and the dysregulated immune system. Furthermore, the high prevalence of epilepsy in SSA (mainly due to perinatal causes) is exacerbated by infections such as toxoplasmosis, neurocysticercosis, onchocerciasis, malaria, bacterial meningitis, tuberculosis, and the immune reactions they elicit. Sleep disorders are another common problem in the region and have been associated with infectious diseases such as human African trypanosomiasis and HIV and involve the activation of the immune system. While most headache disorders are due to benign primary headaches, some secondary headaches are caused by infections (meningitis, encephalitis, brain abscess). HIV and neurosyphilis, both common in SSA, can trigger long-standing immune activation in the central nervous system (CNS) potentially resulting in dementia. Despite the progress achieved in preventing diseases from the poliovirus and retroviruses, these microbes may cause motor neuron diseases in SSA. The immune mechanisms involved in these neurological disorders include increased cytokine levels, immune cells infiltration into the CNS, and autoantibodies. This review focuses on the major neurological disorders relevant to Africa and neuroinfections highly prevalent in SSA, describes the interplay between neuroinfections, immune system, neuroinflammation, and neurological disorders, and how understanding this can be exploited for the development of novel diagnostics and therapeutics for improved patient care.
Collapse
Affiliation(s)
- Leonard Ngarka
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
- Neuroscience Lab, Faculty of Medicine & Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
- Department of Neurology, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Joseph Nelson Siewe Fodjo
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Esraa Aly
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, Safat, Kuwait
| | - Willias Masocha
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, Safat, Kuwait
| | - Alfred K. Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
- Neuroscience Lab, Faculty of Medicine & Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
- Department of Neurology, Yaoundé Central Hospital, Yaoundé, Cameroon
| |
Collapse
|
29
|
AbdElkader AA, Fahmy EM, Ahmad AAF, Labib AA, El-Mekkawy LA, El Razek SSMA. The efficacy of repetitive transcranial magnetic stimulation in treating patients with chronic daily headache. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00278-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Headache is the most common pain disorder, affecting around 66% of the global population. This study aimed to investigate the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) in treating patients with primary chronic daily headaches (chronic tension-type headache and chronic migraine).
Methods
Twenty-seven patients participated in the study, divided into 2 groups: a study group (16 patients) and a control group (11 patients). Treatment consisted of 12 high-frequency (5 Hz) real rTMS sessions, delivered over the left dorsolateral prefrontal cortex (DLPFC), whereas sham rTMS was used for the control group.
Results
Patients of the study group, after real rTMS stimulation, showed a high statistically significant reduction of the measured headache parameters compared to the control group (P value < 0.001), and the percentage of improvement was 94.5%. No significant reduction of headache parameters, after sham rTMS stimulation, was observed in the control group (P value > 0.05) and the percentage of improvement was 7.9%.
Conclusion
High-frequency rTMS is effective in reducing chronic tension headaches and chronic migraines. This finding runs with the approval of the suggested role of DLPFC in pain control. This might open opinions for new treatment strategies in tension-type headache and migraine prevention.
Collapse
|
30
|
Peripheral Nerve Stimulation for Treatment of Headaches: An Evidence-Based Review. Biomedicines 2021; 9:biomedicines9111588. [PMID: 34829819 PMCID: PMC8615534 DOI: 10.3390/biomedicines9111588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/15/2021] [Accepted: 10/26/2021] [Indexed: 01/06/2023] Open
Abstract
Headaches are one of the most common medical complaints worldwide, and treatment is often made difficult because of misclassification. Peripheral nerve stimulation has emerged as a novel treatment for the treatment of intractable headaches in recent years. While high-quality evidence does exist regarding its use, efficacy is generally limited to specific nerves and headache types. While much research remains to bring this technology to the mainstream, clinicians are increasingly able to provide safe yet efficacious pain control.
Collapse
|
31
|
Patel D, Yadav K, Taljaard M, Shorr R, Perry JJ. Effectiveness of Peripheral Nerve Blocks for the Treatment of Primary Headache Disorders: A Systematic Review and Meta-Analysis. Ann Emerg Med 2021; 79:251-261. [PMID: 34756448 DOI: 10.1016/j.annemergmed.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVE Primary headache disorders are prevalent and account for 2% of all emergency department visits. Current treatment options are effective; however, time to pain relief is suboptimal. Alternatives such as peripheral nerve blocks have shown promising results. The objective of this systematic review is to examine the effectiveness of peripheral nerve blocks for timely pain relief. METHODS We searched Ovid MEDLINE, EMBASE, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials and included randomized controlled trials comparing peripheral nerve blocks to placebo or active therapy. The primary outcome was pain within 120 minutes. Secondary outcomes were pain after 120 minutes, adverse events, need for rescue medications, and relapse of headache. Two reviewers screened and extracted data independently; mean differences (MDs) were calculated, and results were pooled using a random-effects model. RESULTS Eleven studies met our eligibility criteria (n=860), of which 9 were included in the meta-analysis. Pain scores were significantly lower in patients treated with peripheral nerve blocks than with placebo at 15 minutes (MD: -1.17; 95% confidence interval: -1.82 to -0.51) and 30 minutes (MD: -0.99; 95% confidence interval: -1.66 to -0.32), and no serious adverse events were reported. Pain scores for peripheral nerve blocks versus active therapy and secondary outcomes were not pooled due to clinical heterogeneity. CONCLUSION Our review shows peripheral nerve blocks are effective as a rapid treatment option when compared to placebo; however, we were unable to assess effectiveness against standard treatment. Emergency physicians should consider peripheral nerve blocks as an adjunct therapy for patients with primary headache disorders.
Collapse
Affiliation(s)
- Dilan Patel
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Krishan Yadav
- Department of Emergency Medicine, University of Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Risa Shorr
- Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jeffrey J Perry
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada; Department of Emergency Medicine, University of Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
32
|
Sedlackova Z, Vita M, Herman J, Furst T, Dornak T, Herman M. Elasticity of neck muscles in cervicogenic headache. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:328-333. [PMID: 34017143 DOI: 10.5507/bp.2021.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the elasticity of the sternocleidomastoid and trapezius muscles in patients with cervicogenic headache and in healthy volunteers. METHODS The medical history of 23 patients with cervicogenic headache was taken with a focus on pain characteristics. Elasticity of the sternocleidomastoid and trapezius muscles was measured by using shear wave elastography. Results were then compared with 23 healthy volunteers. RESULTS The sternocleidomastoid muscle was significantly stiffer in patients with cervicogenic headache compared to healthy volunteers. The stiffness increased gradually from the parasternal area, where it was negligible, to the area near the mastoid process where it reached over 20 kPa. There was no difference in the stiffness of the trapezius muscle. The stiffness of the sternocleidomastoid muscle does show a significant dependence on headache characteristics (e.g., laterality, severity, or frequency). CONCLUSION The results of this pilot study show that patients with cervicogenic headache have a higher stiffness of the sternocleidomastoid muscle than healthy volunteers. These findings suggest that elastography could be used as a diagnostic tool in cervicogenic headache.
Collapse
Affiliation(s)
- Zuzana Sedlackova
- Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, Olomouc, Czech Republic.,Department of Radiological Methods, Faculty of Health Sciences, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, Olomouc, Czech Republic
| | - Martin Vita
- Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, Olomouc, Czech Republic
| | - Jan Herman
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, Olomouc, Czech Republic
| | - Tomas Furst
- Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, Olomouc, Czech Republic
| | - Tomas Dornak
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, Olomouc, Czech Republic
| | - Miroslav Herman
- Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, Olomouc, Czech Republic
| |
Collapse
|
33
|
The Prevalence of Headache and Associated Factors in Al-Kharj, Saudi Arabia: A Cross-Sectional Study. Pain Res Manag 2021; 2021:6682094. [PMID: 33747320 PMCID: PMC7952183 DOI: 10.1155/2021/6682094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/02/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022]
Abstract
Background Only few studies have investigated the prevalence and risk factors of headaches among the Saudi population. The study aimed to estimate the prevalence of headache and to explore its associated risk factors Al-Kharj, Saudi Arabia. Methods The multistage sampling technique was used to enroll 1200 population-based participants who were asked to complete a self-administered questionnaire about headaches, demographics, and several other parameters such as smoking status and different chronic and psychological illnesses. The chi-square test and multivariate logistic regression analysis were used to test the association. Results The overall prevalence of headaches in this study was 3%. The multiple logistic regression analysis showed that females were more likely to have headaches than males (odds ratio (OR) 0.735, 95% confidence interval (CI) = 0.612-1.341; P=0.024). Being a current smoker was also significantly associated with higher "odds" of having headache (OR = 1.319, 95% CI = 0.932-2.462; P=0.037). Participants who were overweight had a significantly higher risk of headache (OR = 1.631, 95% CI = 1.48-1.854; P=0.037). Nonmarried people were significantly more likely to have headache pain, compared to married individuals (OR = 0.875, 95% CI = 0.646-2.317; P=0.047). Conclusion The prevalence of headaches was 3%, and four significant associated factors were identified: females, nonmarried, smoking, and overweight. The temporality of the relationship between these factors and headache cannot be confirmed in this cross-sectional study; so future longitudinal studies are needed to confirm these potential causal relationships.
Collapse
|
34
|
Abstract
Tension-type headaches, associated with young age, poor health, sleep disturbances, anxiety, stress, and poor posture, account for 90% of all headaches diagnosed by healthcare professionals. Diagnosis and treatment of the various headache subtypes are often aimed at determining the underlying cause but commonly involve over-the-counter pain medication. Because recurrence is common in tension-type headaches, with a subsequent refractory response to over-the-counter medications, adjunctive and alternative treatment modalities should be further studied. Here we present a case of tension headache initially non-responsive to pain medication but resolved with osteopathic manipulative treatment and lifestyle modifications. Osteopathic considerations and literature are also reviewed in the broader context of headache management.
Collapse
Affiliation(s)
- Justin Chin
- Medical Education, Lake Erie College of Osteopathic Medicine, Erie, USA.,Family Medicine, LifeLong Medical Care, Richmond, USA
| | - Wenqi Qiu
- Epidemiology and Biostatistics, State University of New York (SUNY) Downstate Health Sciences University, New York, USA
| | | | - Mikhail Volokitin
- Osteopathic Manipulative Medicine, Touro College of Osteopathic Medicine, New York, USA
| |
Collapse
|
35
|
Bahkir FA, Grandee SS. Impact of the COVID-19 lockdown on digital device-related ocular health. Indian J Ophthalmol 2020; 68:2378-2383. [PMID: 33120622 PMCID: PMC7774196 DOI: 10.4103/ijo.ijo_2306_20] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose: Since the declaration of the lockdown due to COVID-19, the usage of digital devices has gone up across the globe, resulting in a challenge for the visual systems of all ages. The purpose of this study is to assess the impact of the lockdown on digital device usage, and consequently, the ocular surface health implications and circadian rhythm abnormalities related to digital eye strain. Methods: An open online survey was sent through various social media platforms and was open for a period of 2 weeks. Results: A total of 407 usable responses were obtained; the average age of respondents was 27.4 years. Typically, 93.6% of respondents reported an increase in their screen time since the lockdown was declared. The average increase in digital device usage was calculated at about 4.8 ± 2.8 h per day. The total usage per day was found to be 8.65 ± 3.74 hours. Sleep disturbances have been reported by 62.4% of people. Typically, 95.8% of respondents had experienced at least one symptom related to digital device usage, and 56.5% said that the frequency and intensity of these symptoms increased since the lockdown was declared. Conclusion: The study highlighted the drastic increase in use of digital devices after the initiation of the COVID-19 lockdown, and along with it, the slow deterioration of ocular health across all age groups. Awareness about prevention of digital eye strain should be stressed, and going forward, measures to bring these adverse effects to a minimum should be explored.
Collapse
Affiliation(s)
- Fayiqa Ahamed Bahkir
- Department of Ophthalmology, Karpaga Vinayaga Institute of Medical Sciences and Research, Chengalpet, Tamil Nadu, India
| | | |
Collapse
|
36
|
Minen MT, Adhikari S, Padikkala J, Tasneem S, Bagheri A, Goldberg E, Powers S, Lipton RB. Smartphone-Delivered Progressive Muscle Relaxation for the Treatment of Migraine in Primary Care: A Randomized Controlled Trial. Headache 2020; 60:2232-2246. [PMID: 33200413 PMCID: PMC8721526 DOI: 10.1111/head.14010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Scalable, accessible forms of behavioral therapy for migraine prevention are needed. We assessed the feasibility and acceptability of progressive muscle relaxation (PMR) delivered by a smartphone application (app) in the Primary Care setting. METHODS This pilot study was a non-blinded, randomized, parallel-arm controlled trial of adults with migraine and 4+ headache days/month. Eligible participants spoke English and owned a smartphone. All participants were given the RELAXaHEAD app which includes an electronic headache diary. Participants were randomized to receive 1 of the 2 versions of the app-one with PMR and the other without PMR. The primary outcomes were measures of feasibility (adherence to the intervention and diary entries during the 90-day interval) and acceptability (satisfaction levels). We conducted exploratory analyses to determine whether there was a change in Migraine Disability Assessment Scale (MIDAS) scores or a change in headache days. RESULTS Of 139 participants (77 PMR, 62 control), 116 (83%) were female, mean age was 41.7 ± 12.8 years. Most patients 108/139 (78%) had moderate-severe disability. Using a 1-5 Likert scale, participants found the app easy to use (mean 4.2 ± 0.7) and stated that they would be happy to engage in the PMR intervention again (mean 4.3 ± 0.6). For the first 6 weeks, participants practiced PMR 2-4 days/week. Mean per session duration was 11.1 ± 8.3 minutes. Relative to the diary-only group, the PMR group showed a greater non-significant decline in mean MIDAS scores (-8.7 vs -22.7, P = .100) corresponding to a small-moderate mean effect size (Cohen's d = 0.38). CONCLUSION Smartphone-delivered PMR may be an acceptable, accessible form of therapy for migraine. Mean effects show a small-moderate mean effect size in disability scores.
Collapse
Affiliation(s)
- Mia T Minen
- Department of Neurology, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | | | - Jane Padikkala
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA
| | - Sumaiya Tasneem
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA
| | - Ashley Bagheri
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA
| | - Eric Goldberg
- Department of Medicine Faculty Group Practices, NYU Langone Health, New York, NY, USA
| | - Scott Powers
- Behavioral Medicine, Headache Medicine, Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Richard B Lipton
- Montefiore Headache Center, Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
- Montefiore Headache Center, Department of Population Health, Albert Einstein College of Medicine, New York, NY, USA
- Montefiore Headache Center, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, USA
| |
Collapse
|
37
|
Heinicke GW, Chen JM, Cox EJ, Zhang KX. A Case of Elevated Intracranial Pressure Diagnosed With Point-of-Care Ocular Ultrasound. Mayo Clin Proc 2020; 95:2046-2048. [PMID: 32771238 DOI: 10.1016/j.mayocp.2020.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/12/2020] [Accepted: 03/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Justin M Chen
- Internal Medicine Residency Spokane, Providence Health & Services, WA
| | - Emily J Cox
- Providence Medical Research Center, Providence Health & Services, Spokane, WA
| | | |
Collapse
|
38
|
Urits I, Gress K, Charipova K, Zamarripa AM, Patel PM, Lassiter G, Jung JW, Kaye AD, Viswanath O. Pharmacological options for the treatment of chronic migraine pain. Best Pract Res Clin Anaesthesiol 2020; 34:383-407. [PMID: 33004155 DOI: 10.1016/j.bpa.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 12/29/2022]
Abstract
Migraine is a debilitating neurological condition with symptoms typically consisting of unilateral and pulsating headache, sensitivity to sensory stimuli, nausea, and vomiting. The World Health Organization (WHO) reports that migraine is the third most prevalent medical disorder and second most disabling neurological condition in the world. There are several options for preventive migraine treatments that include, but are not limited to, anticonvulsants, antidepressants, beta blockers, calcium channel blockers, botulinum toxins, NSAIDs, riboflavin, and magnesium. Patients may also benefit from adjunct nonpharmacological options in the comprehensive prevention of migraines, such as cognitive behavior therapy, relaxation therapies, biofeedback, lifestyle guidance, and education. Preventative therapies are an essential component of the overall approach to the pharmacological treatment of migraine. Comparative studies of newer therapies are needed to help patients receive the best treatment option for chronic migraine pain.
Collapse
Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
| | - Kyle Gress
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Alec M Zamarripa
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Parth M Patel
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Grace Lassiter
- Georgetown University School of Medicine, Washington, DC, USA
| | - Jai Won Jung
- Georgetown University School of Medicine, Washington, DC, USA
| | - Alan D Kaye
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Omar Viswanath
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA; Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA
| |
Collapse
|
39
|
Doane MJ, Gupta S, Vo P, Laflamme AK, Fang J. Associations Between Headache-Free Days and Patient-Reported Outcomes Among Migraine Patients: A Cross-Sectional Analysis of Survey Data in Europe. Pain Ther 2019; 8:203-216. [PMID: 31350710 PMCID: PMC6857199 DOI: 10.1007/s40122-019-0133-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Migraine imposes a substantial burden on patients, society, and healthcare systems. This study aimed to assess the associations between the number of headache-free days (HFDs) and health-related quality of life (HRQoL), work productivity and activity impairment (WPAI), and healthcare resource utilization (HRU) in patients with migraine in the EU5 (France, Germany, Italy, Spain, and the United Kingdom). METHODS This retrospective cross-sectional study collected survey responses from adults aged ≥ 18 years from the 2017 National Health and Wellness Survey (N = 62,000). Migraine patients with a physician's diagnosis of migraine and who had experienced at least 4 monthly headache days in the prior month were included (N = 1569). Number of HFDs was compared with Short-Form 12-Item Survey Instrument, version 2 (SF-12v2) physical and mental component summary scores (PCS and MCS), Short-Form-6D (SF-6D) and EuroQoL-5D (EQ-5D) scores, WPAI, and HRU in migraine patients. Correlation analyses were conducted to test the bivariate associations, whereas generalized linear models were used for multivariable analyses. RESULTS An increase of 1 HFD was associated with average increases of 0.171, 0.306, 0.003, and 0.008 points for MCS, PCS, SF-6D utility score, and EQ-5D index score, respectively (p < 0.001 for all). Extrapolating the results to a tenfold increase in monthly HFDs corresponded to clinically meaningful increases in PCS and EQ-5D scores. An increase of 1 HFD was associated with expected average decreases in absenteeism of 3.9% and presenteeism of 2.1%. Further, an increase of 1 HFD was associated with expected decreases in HCP visits and neurologist visits of 1.0% and 4.7%, respectively. CONCLUSION An increase in the number of HFDs was associated with better health-related outcomes in patients suffering from migraine. Further, the results demonstrate a need for more effective treatments that can reduce migraine frequency and thus improve HRQoL, increase work productivity, and reduce both activity impairment and HRU. FUNDING Novartis Pharma AG, Switzerland.
Collapse
Affiliation(s)
| | | | - Pamela Vo
- Novartis Pharma AG, Fabrikstr. 12, 4002, Basel, Switzerland
| | | | - Juanzhi Fang
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936, USA
| |
Collapse
|
40
|
Hashemi H, Saatchi M, Yekta A, Ali B, Ostadimoghaddam H, Nabovati P, Aghamirsalim M, Khabazkhoob M. High Prevalence of Asthenopia among a Population of University Students. J Ophthalmic Vis Res 2019; 14:474-482. [PMID: 31875103 PMCID: PMC6825687 DOI: 10.18502/jovr.v14i4.5455] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 04/24/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine the prevalence of asthenopia and its associated factors in a
sample of university students in Iran. Methods In this cross-sectional study, participants were selected using multistage
cluster sampling. Presence of at least one of the 10 symptoms—foreign body
sensation, diplopia, blurred vision, eye swelling, dry eye, eye pain,
difficulty in sustaining visual operations, decreased visual acuity,
tearing, and photophobia—was considered as asthenopia. Ocular examinations,
including uncorrected/corrected visual acuity measurement,
objective/subjective refraction, cover test, amplitude of accommodation
(AA), and near point of convergence (NPC) were performed. Results Of the 1,462 students (mean age: 22.8 ± 3.1 years), 73% were women. The age- and
gender-standardized prevalence was 70.9% (95% confidence interval [CI]:
68.3–73.5), 39.8% (95% CI: 36.4–43.1), and 19.7% (95% CI: 16.0–23.3) based
on the presence of at least one, two, and three symptoms, respectively. The
prevalence was significantly higher in females (P = 0.048),
hyperopic students (P< 0.001), and astigmatic participants (P < 0.001). The mean AA and NPC were 9.7 ± 2.6 D and 10.2 ± 4.2 D (P = 0.008) and 7.0 ± 2.1 cm and 7.7 ± 3.9 cm (P< 0.001) in participants with and without asthenopia,
respectively. Multiple regression model revealed age (28–29 years),
astigmatism, and NPC as independent associated factors (odds ratios: 3.51,
1.61, and 0.91, respectively). Conclusion This study shows relatively high prevalence of asthenopia in university
students. Demographic factors and visual system disorders are important risk
factors and timely correction of conditions may lead to decreased
asthenopia.
Collapse
Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran.,Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Mohammad Saatchi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Abbasali Yekta
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Babak Ali
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Ostadimoghaddam
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Payam Nabovati
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mehdi Khabazkhoob
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
41
|
Raucci U, Della Vecchia N, Ossella C, Paolino MC, Villa MP, Reale A, Parisi P. Management of Childhood Headache in the Emergency Department. Review of the Literature. Front Neurol 2019; 10:886. [PMID: 31507509 PMCID: PMC6716213 DOI: 10.3389/fneur.2019.00886] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 07/30/2019] [Indexed: 12/16/2022] Open
Abstract
Headache is the third cause of visits to pediatric emergency departments (ED). According to a systematic review, headaches in children evaluated in the ED are primarily due to benign conditions that tend to be self-limiting or resolve with appropriate pharmacological treatment. The more frequent causes of non-traumatic headache in the ED include primitive headaches (21.8–66.3%) and benign secondary headaches (35.4–63.2%), whereas potentially life-threatening (LT) secondary headaches are less frequent (2–15.3%). Worrying conditions include brain tumors, central nervous system infections, dysfunction of ventriculo-peritoneal shunts, hydrocephalus, idiopathic intracranial hypertension, and intracranial hemorrhage. In the emergency setting, the main goal is to intercept potentially LT conditions that require immediate medical attention. The initial assessment begins with an in-depth, appropriate history followed by a complete, oriented physical and neurological examination. The literature describes the following red flags requiring further investigation (for example neuroimaging) for recognition of LT conditions: abnormal neurological examination; atypical presentation of headaches: subjective vertigo, intractable vomiting or headaches that wake the child from sleep; recent and progressive severe headache (<6 months); age of the child <6 years; no family history for migraine or primary headache; occipital headache; change of headache; new headache in an immunocompromised child; first or worst headache; symptoms and signs of systemic disease; headaches associated with changes in mental status or focal neurological disorders. In evaluating a child or adolescent who is being treated for headache, physicians should consider using appropriate diagnostic tests. Diagnostic tests are varied, and include routine laboratory analysis, cerebral spinal fluid examination, electroencephalography, and computerized tomography or magnetic resonance neuroimaging. The management of headache in the ED depends on the patient's general conditions and the presumable cause of the headache. There are few randomized, controlled trials on pharmacological treatment of headache in the pediatric population. Only ibuprofen and sumatriptan are significantly more effective than placebo in determining headache relief.
Collapse
Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nicoletta Della Vecchia
- Department of Pediatrics, University of "Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Chiara Ossella
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Chiara Paolino
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Rome, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Rome, Italy
| | - Antonino Reale
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant' Andrea Hospital, Rome, Italy
| |
Collapse
|
42
|
Henssen DJHA, Derks B, van Doorn M, Verhoogt N, Van Cappellen van Walsum AM, Staats P, Vissers K. Vagus nerve stimulation for primary headache disorders: An anatomical review to explain a clinical phenomenon. Cephalalgia 2019; 39:1180-1194. [PMID: 30786731 PMCID: PMC6643160 DOI: 10.1177/0333102419833076] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/11/2018] [Accepted: 12/26/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Non-invasive stimulation of the vagus nerve has been proposed as a new neuromodulation therapy to treat primary headache disorders, as the vagus nerve is hypothesized to modulate the headache pain pathways in the brain. Vagus nerve stimulation can be performed by placing an electrode on the ear to stimulate the tragus nerve, which contains about 1% of the vagus fibers. Non-invasive vagus nerve stimulation (nVNS) conventionally refers to stimulation of the cervical branch of the vagus nerve, which is made up entirely of vagal nerve fibers. While used interchangeably, most of the research to date has been performed with nVNS or an implanted vagus nerve stimulation device. However, the exact mechanism of action of nVNS remains hypothetical and no clear overview of the effectiveness of nVNS in primary headache disorders is available. METHODS In the present study, the clinical trials that investigated the effectiveness, tolerability and safety of nVNS in primary headache disorders were systematically reviewed. The second part of this study reviewed the central connections of the vagus nerve. Papers on the clinical use of nVNS and the anatomical investigations were included based on predefined criteria, evaluated, and results were reported in a narrative way. RESULTS The first part of this review shows that nVNS in primary headache disorders is moderately effective, safe and well-tolerated. Regarding the anatomical review, it was reported that fibers from the vagus nerve intertwine with fibers from the trigeminal, facial, glossopharyngeal and hypoglossal nerves, mostly in the trigeminal spinal tract. Second, the four nuclei of the vagus nerve (nuclei of the solitary tract, nucleus ambiguus, spinal nucleus of the trigeminal nerve and dorsal motor nucleus (DMX)) show extensive interconnections. Third, the efferents from the vagal nuclei that receive sensory and visceral input (i.e. nuclei of the solitary tract and spinal nucleus of the trigeminal nerve) mainly course towards the main parts of the neural pain matrix directly or indirectly via other vagal nuclei. CONCLUSION The moderate effectiveness of nVNS in treating primary headache disorders can possibly be linked to the connections between the trigeminal and vagal systems as described in animals.
Collapse
Affiliation(s)
- Dylan Jozef Hendrik Augustinus Henssen
- Department of Anatomy, Donders Institute
for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the
Netherlands
- Department of Neurosurgery, Radboud
University Medical Center, Nijmegen, the Netherlands
| | - Berend Derks
- Department of Anatomy, Donders Institute
for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the
Netherlands
| | - Mats van Doorn
- Department of Anatomy, Donders Institute
for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the
Netherlands
| | - Niels Verhoogt
- Department of Anatomy, Donders Institute
for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the
Netherlands
| | | | | | - Kris Vissers
- Department of Anesthesiology, Pain and
Palliative Medicine, Radboud University Medical Center, Nijmegen, the
Netherlands
| |
Collapse
|
43
|
Chronic Headache: a Review of Interventional Treatment Strategies in Headache Management. Curr Pain Headache Rep 2019; 23:68. [PMID: 31359257 DOI: 10.1007/s11916-019-0806-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF THE REVIEW To provide an overview of current interventional pain management techniques for primary headaches with a focus on peripheral nerve stimulation and nerve blocks. RECENT FINDINGS Despite a plethora of treatment modalities, some forms of headaches remain intractable to conservative therapies. Interventional pain modalities have found a niche in treating headaches. Individuals resistant to common regimens, intolerant to pharmaceutical agents, or those with co-morbid factors that cause interactions with their therapies are some instances where interventions could be considered in the therapeutic algorithm. In this review, we will discuss these techniques including peripheral nerve stimulation, third occipital nerve block (TON), lesser occipital nerve block (LON), greater occipital nerve block (GON), sphenopalatine block (SPG), radiofrequency ablation (RFA), and cervical epidural steroid injections (CESI). Physicians have used several interventional techniques to treat primary headaches. While many can be treated pharmacologically, those who continue to suffer from refractory or severe headaches may see tremendous benefit from a range of more invasive treatments which focus on directly inhibiting the painful nerves. While there is a plethora of evidence suggesting these methods are effective and possibly durable interventions, there is still a need for large, prospective, randomized trials to clearly demonstrate their efficacy.
Collapse
|
44
|
Davies PT, Lane RJ, Astbury T, Fontebasso M, Murphy J, Matharu M. The long and winding road: the journey taken by headache sufferers in search of help. Prim Health Care Res Dev 2019; 20:e4. [PMID: 29848391 PMCID: PMC6476391 DOI: 10.1017/s1463423618000324] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 02/18/2018] [Accepted: 04/02/2018] [Indexed: 01/03/2023] Open
Abstract
AimTo outline the pathways a cohort of first attendees to our headache clinics had taken over the years in search of explanations and treatment for their headaches. To establish a greater awareness of the shortcomings and failures in their medical journey in the hope that better headache management will emerge in primary care. BACKGROUND: At first attendance in primary care most headache sufferers will not receive a firm diagnosis. Treatments provided are often ineffective and so many patients embark on a somewhat random self-made journey searching for a remedy. If they reach a Headache Clinic the most common diagnoses are 'chronic migraine' and 'medication overuse headache'. They are either no better or worse than when their headaches first started despite their efforts. METHOD: We undertook a prospective questionnaire-based study of over 200 patients on first attendance at each of our headache clinics, three based in District General Hospitals and one in a tertiary referral centre. We documented the patients' headache characteristics, the 'burden' of their headaches, functional handicap and the financial costs incurred seeking help before referral. We also documented what our patients understood about their headache disorder and the treatments previously tried.FindingsMost patients had not been given a formal diagnosis in primary care and many remained unconvinced of the benign nature of their headache problem and wanted further investigations. A few had sought help from headache charities. Many had unrealistic attitudes to their problem and medication overuse was rife. A few patients had been offered triptans in primary care. Key deficiencies in the primary care management of these patients included failure to provide a formal headache diagnosis, inadequate understanding of the nature and mechanism of headaches and failure to follow a resilient management strategy. We provide a more effective management pathway in primary care.
Collapse
Affiliation(s)
- Paul T.G. Davies
- Department of Neurology, Northampton General Hospital, Billing Road, Northampton, UK
- Consultant Neurologist, Northampton General Hospital, Northampton, UK
- Honorary Senior Lecturer, Clinical Neurology Radcliffe Infirmary, Oxford, UK
| | | | - Theresa Astbury
- Department of Neurology, Northampton General Hospital, Billing Road, Northampton, UK
| | | | - Jill Murphy
- York Headache Clinic (York District Hospital), York, UK
| | - Manjit Matharu
- The London Headache Group, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| |
Collapse
|
45
|
Jose A, Prasad RS, Pai A. Trigeminal autonomic cephalalgias: The impersonators. INDIAN JOURNAL OF PAIN 2019. [DOI: 10.4103/ijpn.ijpn_2_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
46
|
Agosti R. Migraine Burden of Disease: From the Patient's Experience to a Socio-Economic View. Headache 2018; 58 Suppl 1:17-32. [DOI: 10.1111/head.13301] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/28/2018] [Accepted: 03/28/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Reto Agosti
- Headache Center Zurich Hirslanden; Zurich Switzerland
| |
Collapse
|
47
|
Uddin MS, Al Mamun A, Asaduzzaman M, Hosn F, Abu Sufian M, Takeda S, Herrera-Calderon O, Abdel-Daim MM, Uddin GS, Noor MAA, Begum MM, Kabir MT, Zaman S, Sarwar MS, Rahman MM, Rafe MR, Hossain MF, Hossain MS, Ashraful Iqbal M, Sujan MAR. Spectrum of Disease and Prescription Pattern for Outpatients with Neurological Disorders: An Empirical Pilot Study in Bangladesh. Ann Neurosci 2018; 25:25-37. [PMID: 29887680 PMCID: PMC5981591 DOI: 10.1159/000481812] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/01/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Neurological disorders represent one of the most prominent causes of morbidity and mortality that adversely affect the lifestyle of patients and a major percentage of these diseases exists in developing countries. PURPOSE The objective of this study was to examine the prevalence and prescription pattern for outpatients with neurological disorders in Bangladesh. METHODS The study was conducted on 1,684 patients in 6 hospitals (National Institute of Neurosciences and Hospital, Dhaka Medical College and Hospital, Bangabandhu Sheikh Mujib Medical University, Shaheed Suhrawardy Medical College, Sir Salimullah Medical College, and Apollo Hospitals Dhaka) of the Dhaka City from March 2014 to June 2015. Data were collected through a predesigned questionnaire from the patients that contain information about gender, age, marital status, occupation, residential status, affected disease, self-medicated medicines, and prescribed medicines. RESULTS Out of 1,684 patients, 28.38% patients were aged 51-60 years and male, 57.19% predominance. The study exposed headache and migraine for 29.75% patients, followed by stroke for 23.93% patients and seizure for 7.07% patients. Genetic reason for the neurological disorders was seen only among 12.35% patients. In this study, 16.98% patients had been affected by neurological disorders for more than 2 years and 19% of patients for less than 6 months. Most extensively prescribed medicines were multivitamins and multiminerals used by 17.89% of patients followed by nonsteroidal anti-inflammatory drugs and other analgesic by 14.84%; afterwards antiulcerants were used by 12.62%, subsequently anticoagulants were used by 11.61% followed by antihyperlipidemic medicines by 10.26% and antiepileptic drugs by 8.08% of patients. The crucial reasons for the selection of prescribed medicines were the confidence that patients had with the physician's prescribed medicines, which was shown for 40.97% patients and knowledge of the medicines was reported for 35.04% patients. The period of prescribed medicine usage was 1-3 months for 39.73% patients and 3-6 months for 29.16% patients. The patient's compliance for prescribed medicines was satisfactory for 34.56% patients, good for 28.15% patients, and side effects were reported for 23.22% patients. CONCLUSION In Bangladesh, it is not surprising to note that neurological diseases are more prevalent than other different diseases among different age groups and genders. Headache and migraine, stroke and seizure are most frequently encountered neurological disorders here. Treatment procedure of these disorders is not quite suitable due to the anomalies of health care management systems. Appropriate management of the health care system, especially the placement of hospital and community pharmacy can overcome the existing inconsistencies as well as increase the knowledge, awareness, and perception of the patients about health and neurological disorders.
Collapse
Affiliation(s)
- Md. Sahab Uddin
- Department of Pharmacy, Southeast University, Dhaka, Bangladesh
| | | | - Md. Asaduzzaman
- Department of Pharmacy, Southeast University, Dhaka, Bangladesh
| | - Fakhrul Hosn
- Department of Pharmacy, Southeast University, Dhaka, Bangladesh
| | | | - Shinya Takeda
- Department of Clinical Psychology, Tottori University Graduate School of Medical Sciences, Tottori, Japan
| | - Oscar Herrera-Calderon
- Academic Department of Pharmaceutical Sciences, Faculty of Pharmacy and Biochemistry, Universidad Nacional San Luis Gonzaga de Ica, Ica, Peru
| | - Mohamed M. Abdel-Daim
- Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - G.M. Sala Uddin
- Department of Pharmacy, Southeast University, Dhaka, Bangladesh
| | | | | | | | - Sonia Zaman
- Department of Pharmacy, Southeast University, Dhaka, Bangladesh
| | - Md. Shahid Sarwar
- Department of Pharmacy, Noakhali Science and Technology University, Noakhali, Bangladesh
| | | | | | - Md. Farhad Hossain
- Department of Physical Therapy, Graduate School of Inje University, Gimhae, Republic of Korea
| | | | | | | |
Collapse
|
48
|
Carlsen LN, Westergaard ML, Bisgaard M, Schytz JB, Jensen RH. National awareness campaign to prevent medication-overuse headache in Denmark. Cephalalgia 2017; 38:1316-1325. [DOI: 10.1177/0333102417736898] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Medication-overuse headache is prevalent, but in principle preventable. Objective To describe the Danish national awareness campaign for medication-overuse headache. Methods The Danish Headache Center, the Association of Danish Pharmacies, and headache patient organizations implemented a four-month medication-overuse headache awareness campaign in 2016. Target groups were the general public, general practitioners, and pharmacists. Key messages were: Overuse of pain-medication can worsen headaches; pain-medication should be used rationally; and medication-overuse headache is treatable. A range of communication technologies was used. A survey on the public’s awareness of medication-overuse headache was conducted. Results The Danish adult population is 4.2 million. Online videos were viewed 297,000 times in three weeks. All 400 pharmacies received campaign materials. Over 28,000 leaflets were distributed. Two radio interviews were conducted. A television broadcast about headache reached an audience of 520,000. Forty articles were published in print media. Information was accessible at 32 reputable websites and five online news agencies. Three scientific papers were published. Information was available at an annual conference of general practitioners, including a headache lecture. The survey showed an increase in percentage of the public who knew about medication-overuse headache (from 31% to 38%). Conclusion A concerted campaign to prevent medication-overuse headache can be implemented through involvement of key stakeholders.
Collapse
Affiliation(s)
- Louise Ninett Carlsen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | | | - Mette Bisgaard
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | | | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| |
Collapse
|
49
|
Bega D. Complementary and Integrative Interventions for Chronic Neurologic Conditions Encountered in the Primary Care Office. Prim Care 2017; 44:305-322. [DOI: 10.1016/j.pop.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
50
|
Affiliation(s)
- Olivia Begasse de Dhaem
- From New York Presbyterian Hospital (O.B.d.D.), Columbia University; and New York University Langone Medical Center (M.T.M.), New York.
| | - Mia T Minen
- From New York Presbyterian Hospital (O.B.d.D.), Columbia University; and New York University Langone Medical Center (M.T.M.), New York
| |
Collapse
|