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Carvalho LCLS, Silva PAD, Rocha-Filho PAS. Persistent headache and chronic daily headache after COVID-19: a prospective cohort study. Korean J Pain 2024; 37:247-255. [PMID: 38881283 DOI: 10.3344/kjp.24046] [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: 02/13/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 06/18/2024] Open
Abstract
Background Little is known about the frequency and impact of the persistent headache and about the incidence of chronic daily headache (CDH) after coronavirus disease 2019 (COVID-19). The aim of this prospective cohort study was to assess the incidence, risk factors, characteristics, and impact of CDH in patients with COVID-19. Methods In the first stage, 288 patients were interviewed by telephone after the acute phase of COVID-19. Subsequently, 199 patients who presented headache were reinterviewed at least one year after COVID-19. Headaches that persisted beyond the acute phase of COVID-19 for three or more months and presented frequency ≥ 45 days over the first three months were considered to be CDH. Results One hundred and twenty-three patients were included, 56% were females; median age: 50 years (25th and 75th percentile: 41;58). The headache persisted beyond the acute phase of COVID-19 in 52%, and 20.3% had CDH (95% confidence interval: 13.6-28.2). Individuals who previously had headaches and who had headaches of greater intensity during the acute phase were at higher risk of developing CDH. The group with CDH included more females, greater impact of headache, more persistence of headache beyond the 120th day of COVID-19 and less throbbing headache than did the other individuals whose headache persisted. Conclusions Patients who had COVID-19 had a high incidence of CDH. Previous headache and greater intensity of headache were associated with higher risk of CDH.
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Affiliation(s)
| | - Priscila Aparecida da Silva
- Scientific Initiation Fellowships Institutional Program (CNPq/PROPESQI-UFPE), Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Pedro Augusto Sampaio Rocha-Filho
- Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE), Recife, Brazil
- Division of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
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2
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Kalika P, Monteith TS. New Daily Persistent Headache in the Pediatric and Adolescent Population: An Updated Review. Life (Basel) 2024; 14:724. [PMID: 38929707 PMCID: PMC11204919 DOI: 10.3390/life14060724] [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: 04/27/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE OF REVIEW New daily persistent headache (NDPH) is a primary headache disorder characterized by the sudden onset of continuous pain and its intractability to treatment. It is more prevalent in the pediatric population than the adult population, but remains understudied and underdiagnosed. The purpose of the current article is to provide a current overview of new daily persistent headache in the pediatric and adolescent population, including history, pathophysiology, clinical findings, current and emerging treatment options, and the results of recent studies and meta-analyses. RECENT FINDINGS Despite recent studies and meta-analyses showing significant phenotypic overlap between chronic migraine and NDPH in the pediatric population, multiple recent studies have come to conflicting conclusions about the overlap of medication overuse in headache and pediatric NDPH. Recent studies reveal alterations in neuroimaging, particularly in functional connectivity, in patients with NDPH. Patients frequently remain treatment-refractory even to medications that have historically proven helpful in this population; however, new treatment options, including calcitonin gene-related peptide (CGRP) monoclonal antibodies, may be more effective. SUMMARY NPDH remains a perplexing and difficult-to-manage condition for both children and adults. Despite a higher prevalence in the pediatric population, there are relatively few studies to guide the evaluation and treatment of NDPH in pediatric and adolescent patients. Early treatment, both pharmacological and non-pharmacological, should be employed to reduce disability. Overall, further studies are needed to better understand pathogenesis and to identify more effective therapeutic strategies, both pharmacological and non-pharmacological.
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Affiliation(s)
- Paige Kalika
- Division of Pediatric Neurology, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Teshamae S. Monteith
- Division of Headache Medicine, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
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3
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Linnet T, Hussein M, Schytz HW, Bendtsen L, Amin FM. Challenges in the management of new daily persistent headache at a tertiary headache center-A retrospective real-world evidence study. Headache 2024; 64:509-515. [PMID: 38646979 DOI: 10.1111/head.14715] [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: 09/14/2023] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE In this retrospective cross-sectional real-world evidence study from the Danish Headache Center (DHC), a national tertiary headache center in Denmark, we sought to identify potential pharmacological agents for the treatment of new daily persistent headache (NDPH). BACKGROUND NDPH is an enigmatic headache disorder with abrupt onset and chronic duration for which evidence-based treatments are lacking. NDPH is a diagnosis of exclusion, for which secondary headaches must be ruled out and the etiology remains idiopathic. The sparse investigations of this disorder have not yielded a pathophysiological basis and no effective treatment for NDPH has been found. METHODS All patients with an NDPH diagnosis at the DHC were enrolled (n = 64). First, we reviewed the records of all patients with an NDPH diagnosis to evaluate whether they fulfilled the diagnostic criteria. Next, we extracted all the trialled acute and prophylactic pharmacological interventions for the included patients. Then, pharmacological interventions that had been tried in ≥ 20 patients were analyzed post hoc with efficacy as the outcome, which was stratified in five effect categories ("no effect," "partial effect," "full effect," "partial effect and cessation due to adverse events," and "full effect and cessation due to adverse events"). Descriptive statistical analysis was performed, and the results were schematically presented (see Table 2). RESULTS Fifty-one patients out of 64 were found to fulfill NDPH criteria and were included in the study. The drugs tried by ≥ 20 patients were amitriptyline (n = 34), candesartan (n = 27), and mirtazapine (n = 20). No patients experienced a complete effect with these drugs while 9% (3/34), 26% (7/27), and 15% (3/20) experienced a partial effect with no adverse events that led to treatment discontinuation, respectively. The remaining patients experienced either no effect or a partial effect with adverse events leading to treatment discontinuation. CONCLUSION In this study we add real-world evidence to suggest that prophylactic drugs conventionally used for treating chronic migraine and chronic tension-type headache have limited utility for treating NDPH; however, a partial response in 26% of patients using candesartan and 15% of patients using mirtazapine warrants further investigation in randomized double-blinded placebo-controlled trials.
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Affiliation(s)
- Thor Linnet
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Marwa Hussein
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henrik Winther Schytz
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lars Bendtsen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Faisal Mohammad Amin
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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4
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Orr SL. Headache in Children and Adolescents. Continuum (Minneap Minn) 2024; 30:438-472. [PMID: 38568493 DOI: 10.1212/con.0000000000001414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVE This article reviews the assessment of children and adolescents presenting with headache, provides an overview of primary headache disorders, and reviews evidence-based management of headache in this age group. LATEST DEVELOPMENTS In the last few years, new epidemiological data have shed light on less common pediatric headache disorders (eg, pediatric trigeminal autonomic cephalalgias) and psychosocial risk factors associated with primary headache disorders in children and adolescents. There has also recently been a substantial increase in interventions that target the calcitonin gene-related peptide pathway and that treat primary headache disorders using noninvasive neuromodulation. Although these interventions have primarily been studied in adults, there is emerging evidence of their use in the pediatric population. ESSENTIAL POINTS Primary headache disorders are very common in youth, and the most commonly encountered headache diagnosis in neurology practice is migraine, which affects approximately 10% of children and adolescents. Diagnosing and effectively treating primary headache disorders before adulthood may have a sustained impact on the patient by improving long-term headache and mental health outcomes, thereby significantly reducing the burden of disability over time. There are several available and emerging acute and preventive interventions for youth with primary headache disorders, and treatment decisions should be made in the context of available evidence using a shared decision-making approach.
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5
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AlGhamdi K, Sadler K. The Use of Ketamine for Malignant and Nonmalignant Chronic Pain in Children: A Review of Current Evidence. J Pain Palliat Care Pharmacother 2024; 38:45-55. [PMID: 38010998 DOI: 10.1080/15360288.2023.2284976] [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: 06/09/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023]
Abstract
Chronic pain in children continues to pose significant challenges. The pharmacological approach most often revolves around trials and errors, expert opinions, and extrapolation of adult study findings. Ketamine is one of the agents used for chronic pain, especially with a neuropathic component. This article aims to provide an overview of its properties and highlight the current evidence for its use in malignant and nonmalignant chronic pain management. A search on the use of ketamine for chronic pain in children up to 18 years of age covering the period from January 1, 2000, to December 14, 2022, was performed through PubMed, Cochrane Library, EBSCO, EBM Review, Wiley, BMJ, Web of Science, Google Scholar, and the Saudi Digital Library. 218 articles were found and 42 underwent full review. Currently, the evidence about ketamine efficacity and safety for chronic pain management is at best of moderate to low quality. The heterogeinity of ketamine infusion protocols and frequent concomitant use of other analgesics make it difficult to draw robust conclusions. The long-term effect of prolonged usage also remains a concern. Nevertheless, with careful monitoring, the drug may be a reasonable choice for malignant and nonmalignant pain management in selected cases, especially for refractory pain not responding to conventional approaches.
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Affiliation(s)
- Khaled AlGhamdi
- Consultant Pediatric Complex/Palliative Care, Pediatrics Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
- Assistant Professor, Al-Faisal University, Riyadh, Saudi Arabia
| | - Kim Sadler
- Advanced Clinical Specialist Nurse, Palliative Care, Oncology Nursing Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Wang W, Qiu D, Mei Y, Bai X, Yuan Z, Zhang X, Xiong Z, Tang H, Zhang P, Zhang Y, Yu X, Wang Z, Ge Z, Sui B, Wang Y. Altered functional connectivity of brainstem nuclei in new daily persistent headache: Evidence from resting-state functional magnetic resonance imaging. CNS Neurosci Ther 2024; 30:e14686. [PMID: 38516817 PMCID: PMC10958407 DOI: 10.1111/cns.14686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/16/2024] [Accepted: 03/07/2024] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVES The new daily persistent headache (NDPH) is a rare primary headache disorder. However, the underlying mechanisms of NDPH remain incompletely understood. This study aims to apply seed-based analysis to explore the functional connectivity (FC) of brainstem nuclei in patients with NDPH using resting-state functional magnetic resonance imaging (MRI). METHODS The FC analysis from the region of interest (ROI) to whole brain voxels was used to investigate 29 patients with NDPH and 37 well-matched healthy controls (HCs) with 3.0 Tesla MRI. The 76 nuclei in the brainstem atlas were defined as ROIs. Furthermore, we explored the correlations between FC and patients' clinical characteristics and neuropsychological evaluations. RESULTS Patients with NDPH exhibited reduced FC in multiple brainstem nuclei compared to HCs (including right inferior medullary reticular formation, right mesencephalic reticular formation, bilateral locus coeruleus, bilateral laterodorsal tegmental nucleus-central gray of the rhombencephalon, median raphe, left medial parabrachial nucleus, periaqueductal gray, and bilateral ventral tegmental area-parabrachial pigmented nucleus complex) and increased FC in periaqueductal gray. No significant correlations were found between the FC of these brain regions and clinical characteristics or neuropsychological evaluations after Bonferroni correction (p > 0.00016). CONCLUSIONS Our results demonstrated that patients with NDPH have abnormal FC of brainstem nuclei involved in the perception and regulation of pain and emotions.
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Affiliation(s)
- Wei Wang
- Department of Neurology, Headache Center, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Dong Qiu
- Department of Neurology, Headache Center, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yanliang Mei
- Department of Neurology, Headache Center, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Xiaoyan Bai
- Tiantan Neuroimaging Center of ExcellenceChina National Clinical Research Center for Neurological DiseasesBeijingChina
- Department of Radiology, Beijing Neurosurgical Institute, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Ziyu Yuan
- Department of Neurology, Headache Center, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Xue Zhang
- Tiantan Neuroimaging Center of ExcellenceChina National Clinical Research Center for Neurological DiseasesBeijingChina
- Department of Radiology, Beijing Neurosurgical Institute, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Zhonghua Xiong
- Department of Neurology, Headache Center, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Hefei Tang
- Department of Neurology, Headache Center, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Peng Zhang
- Department of Neurology, Headache Center, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yaqing Zhang
- Department of Neurology, Headache Center, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Xueying Yu
- Department of Neurology, Headache Center, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Zhe Wang
- Department of NeurologyThe First Affiliated Hospital of Dalian Medical UniversityDalianLiaoningChina
| | - Zhaoli Ge
- Department of NeurologyShenzhen Second People's HospitalShenzhenGuangdongChina
| | - Binbin Sui
- Tiantan Neuroimaging Center of ExcellenceChina National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yonggang Wang
- Department of Neurology, Headache Center, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
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Atalar AÇ, Genç H, Ur Özçelik E, Bolay H, Uluduz D, Unal-Cevik, Kissani N, Luvsannorov O, Togha M, Ozge A, Baykan B. Other primary headache disorders: Data from the HEAD-MENA-A study in Africa, Asia, and the Middle East. Clin Neurol Neurosurg 2024; 236:108112. [PMID: 38232607 DOI: 10.1016/j.clineuro.2023.108112] [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: 10/14/2023] [Revised: 12/22/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE Other primary headache disorders (OPHD) are under-investigated compared to frequent primary headache types like migraine, tension-type headache, and trigeminal autonomic cephalalgias. Knowledge of the distribution and characteristics of OPHD subtypes is crucial for their recognition. We aimed to determine the prevalence at the hospital and headache clinics and clinical characteristics of OPHDs in patients from 13 countries. METHODS We analyzed a large dataset from the cross-sectional study Head-MENA-A (Middle East, North Africa, Asia). Consecutive patients over 10 years of age presenting with headaches were included from outpatient, inpatient, and emergency settings. A structured questionnaire addressing demographics, headache characteristics, accompanying symptoms, and triggers was administered. Headache subtypes were diagnosed according to the ICHD-3 criteria. RESULTS Among patients complaining of headaches (n = 3722), 106 (2.9%) were diagnosed with OPHD. Fifty-two patients (1.4% of all headache patients) had only OPHD, while 54 (1.5%) had both OPHD and a co-existing primary headache (mostly migraine). All OPHDs were more common in females. The most frequent subtypes were new daily persistent headache and primary stabbing headache (0.2% each among all admitted patients). Photophobia and phonophobia were the most frequent accompanying symptoms, while physical activity (28.8%), stress (15.4%), and the Valsalva maneuver (15.4%) were the most common triggering factors. The majority of triggering factors were more pronounced in patients with both migraine and OPHD. CONCLUSIONS Other primary headaches are rare and heterogeneous. Their high co-existence with migraine suggests shared predisposing factors, hinting at a "headache continuum" concept for primary headaches.
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Affiliation(s)
- A Ç Atalar
- Health Sciences University, Kanuni Sultan Süleyman Education and Research Hospital, Department of Neurology, Istanbul, Turkiye.
| | - H Genç
- University of Health Sciences, Van Training and Research Hospital, Van, Turkiye
| | - E Ur Özçelik
- Health Sciences University, Kanuni Sultan Süleyman Education and Research Hospital, Department of Neurology, Istanbul, Turkiye
| | - H Bolay
- Gazi University, Medical Faculty, Department of Neurology and Algology, NOROM, Ankara, Turkiye
| | - D Uluduz
- Istanbul University-Cerrahpaşa, Medical Faculty, Department of Neurology, Istanbul, Turkiye
| | - Unal-Cevik
- Hacettepe University, Medical Faculty, Department of Neurology, Ankara, Turkiye
| | - N Kissani
- Neuroscience Research Laboratory in Marrakech Medical School, Cadi Ayyad University, Marrakech, Morocco
| | - O Luvsannorov
- Mongolian National University of Medical Sciences, Department of Neurology, Ulaanbaatar, Mongolia
| | - M Togha
- Tehran University of Medical Sciences, School of Medicine, Department of Neurology, Tehran, Iran
| | - A Ozge
- Mersin University, Medical Faculty, Department of Neurology, Mersin, Turkiye
| | - B Baykan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkiye; EMAR Medical Center, Istanbul, Turkiye
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8
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Carrión-Nessi FS, Ascanio LC, Pineda-Arapé AG, Omaña-Ávila ÓD, Mendoza-Millán DL, Romero SR, Almao-Rivero AB, Camejo-Ávila NA, Gebran-Chedid KJ, Rodriguez-Saavedra CM, Freitas-De Nobrega DC, Castañeda SA, Forero-Peña JL, Delgado-Noguera LA, Meneses-Ramírez LK, Cotuá JC, Rodriguez-Morales AJ, Forero-Peña DA, Paniz-Mondolfi AE. New daily persistent headache after SARS-CoV-2 infection in Latin America: a cross-sectional study. BMC Infect Dis 2023; 23:877. [PMID: 38097988 PMCID: PMC10722794 DOI: 10.1186/s12879-023-08898-2] [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: 09/16/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Persistent headache is a frequent symptom after coronavirus disease 2019 (COVID-19) and there is currently limited knowledge about its clinical spectrum and predisposing factors. A subset of patients may be experiencing new daily persistent headache (NDPH) after COVID-19, which is among the most treatment-refractory primary headache syndromes. METHODS We conducted a cross-sectional study in Latin America to characterize individuals with persistent headache after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to identify factors associated with NDPH. Participants over 18 years old who tested positive for SARS-CoV-2 infection and reported persistent headache among their symptoms completed an online survey that included demographics, past medical history, persistent headache clinical characteristics, and COVID-19 vaccination status. Based on participants' responses, NDPH diagnostic criteria were used to group participants into NDPH and non-NDPH groups. Participant data was summarized by descriptive statistics. Student's t and Mann-Whitney U tests were used according to the distribution of quantitative variables. For categorical variables, Pearson's chi-square and Fisher's exact tests were used according to the size of expected frequencies. Binomial logistic regression using the backward stepwise selection method was performed to identify factors associated with NDPH. RESULTS Four hundred and twenty-one participants from 11 Latin American countries met the inclusion criteria. One in four participants met the NDPH diagnostic criteria. The mean age was 40 years, with most participants being female (82%). Over 90% of the participants reported having had mild/moderate COVID-19. Most participants had a history of headache before developing COVID-19 (58%), mainly migraine type (32%). The most predominant clinical characteristics in the NDPH group were occipital location, severe/unbearable intensity, burning character, and radiating pain (p < 0.05). A higher proportion of anxiety symptoms, sleep problems, myalgia, mental fog, paresthesia, nausea, sweating of the face or forehead, and ageusia or hypogeusia as concomitant symptoms were reported in participants with NDPH (p < 0.05). Palpebral edema as a concomitant symptom during the acute phase of COVID-19, occipital location, and burning character of the headache were risk factors associated with NDPH. CONCLUSION This is the first study in Latin America that explored the clinical spectrum of NDPH after SARS-CoV-2 infection and its associated factors. Clinical evaluation of COVID-19 patients presenting with persistent headache should take into consideration NDPH.
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Affiliation(s)
- Fhabián S Carrión-Nessi
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Luis C Ascanio
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Andreína G Pineda-Arapé
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
| | - Óscar D Omaña-Ávila
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Daniela L Mendoza-Millán
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Sinibaldo R Romero
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Medical Scientist Training Program (MD/PhD), University of Minnesota Medical School, Minneapolis, MN, USA
| | - Abranny B Almao-Rivero
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
| | - Natasha A Camejo-Ávila
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
| | | | | | - Diana C Freitas-De Nobrega
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
| | - Sergio A Castañeda
- Centro de Investigaciones en Microbiología y Biotecnología, Facultad de Ciencias Naturales, Universidad del Rosario (CIMBIUR), Universidad del Rosario, Bogotá, Colombia
| | - José L Forero-Peña
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
| | - Lourdes A Delgado-Noguera
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela
| | - Lucianny K Meneses-Ramírez
- "Dr. Francisco Battistini Casalta" Health Sciences School, University of Oriente - Bolivar Nucleus, Ciudad Bolivar, Venezuela
| | - Juan C Cotuá
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
| | - Alfonso J Rodriguez-Morales
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
- Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru
| | - David A Forero-Peña
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela.
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela.
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela.
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela.
| | - Alberto E Paniz-Mondolfi
- Department of Infectious Diseases and Tropical Medicine, Venezuelan Science Incubator, Barquisimeto, Venezuela.
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
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Sadeghpour M, Abdolizadeh A, Yousefi P, Rastegar-Kashkouli A, Chitsaz A. New Daily Persistent Headache (NDPH): Unraveling the Complexities of Diagnosis, Pathophysiology, and Treatment. Curr Pain Headache Rep 2023; 27:551-559. [PMID: 37632682 DOI: 10.1007/s11916-023-01161-y] [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] [Accepted: 07/31/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE OF REVIEW The current article aims to provide an overview of new daily persistent headache (NDPH), with a particular emphasis on its pathophysiology, evaluation, and current treatment options. RECENT FINDINGS NDPH is an uncommon and heterogeneous condition associated with various comorbidities and is of great significance due to its prolonged duration and high severity. Variable causes and clinical aspects of NDPH may reflect differences in its underlying pathophysiological mechanisms, including genetics, environmental triggers, neuroinflammation, and brain changes. When assessing a patient with NDPH, potential triggers, past medical history, and differential diagnosis should be carefully considered. Non-pharmacological interventions aimed to improve diet, sleep patterns, and reduce consumption of caffeine and alcohol are recommended for all patients. Nerve blockade and nerve stimulation seem to be more efficacious in children than adults. Antiviral medications and neuroinflammation-targeting treatments may be helpful, particularly, when an infectious disease or severe inflammation is suspected. NDPH patients with concurrent affective disorders may benefit from treatment with serotonin reuptake inhibitors, serotonin/norepinephrine reuptake inhibitors, or benzodiazepines. Cerebrospinal-fluid-lowering medications may be useful for headaches started with a thunderclap or a Valsalva maneuver. Possible treatments for refractory NDPH include intravenous ketamine or lidocaine, onabotulinumtoxinA, and calcitonin gene-related peptide antibodies. Considering the variety of NDPH, it is critical to properly screen patients for correct diagnosis. Proper identification of potential mimics may enable precise therapy opportunities, yet there is no gold standard treatment for NDPH. Further well-designed studies are needed to elucidate the underlying mechanisms and develop effective treatment strategies for NDPH.
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Affiliation(s)
- Majid Sadeghpour
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Abdolizadeh
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Pourya Yousefi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Ahmad Chitsaz
- Department of Neurology, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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10
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Mei Y, Wang W, Qiu D, Yuan Z, Bai X, Tang H, Zhang P, Zhang X, Zhang Y, Yu X, Sui B, Wang Y. Micro-structural white matter abnormalities in new daily persistent headache: a DTI study using TBSS analysis. J Headache Pain 2023; 24:80. [PMID: 37394419 DOI: 10.1186/s10194-023-01620-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND New daily persistent headache (NDPH) is a rare primary headache disorder characterized by daily and persistent sudden onset headaches. The pathogenesis of NDPH remains unclear, and there are few white matter imaging studies related to NDPH. The purpose of this study was to investigate the micro-structural abnormalities of white matter in NDPH and provided insights into the pathogenesis of this disease based on tract-based spatial statistics (TBSS). METHODS Twenty-one patients with NDPH and 25 healthy controls (HCs) were included in this study. T1 structural and diffusion magnetic resonance imaging (MRI) were acquired from all participants. Differences in the fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) between patients with NDPH and HCs were investigated using TBSS analysis. RESULTS Significantly decreased FA, increased MD and RD were found in patients with NDPH compared to HCs. White matter regions overlaid with decreased FA, increased MD and RD were found in 16 white matter tracts from the Johns Hopkins University ICBM-DTI-81 White-Matter Atlas and Johns Hopkins University White-Matter Tractography Atlas. Specifically, these white matter regions included the right anterior thalamic radiation (ATR), body of the corpus callosum (BCC), bilateral cingulum, left hippocampal cingulum (CGH), left corticospinal tract (CST), forceps major, fornix, left inferior fronto-occipital fasciculus (IFOF), bilateral inferior longitudinal fasciculus (ILF), left posterior limb of the internal capsule (PLIC), right retrolenticular part of the internal capsule (RPIC), splenium of the corpus callosum (SCC), right superior longitudinal fasciculus (SLF) and left uncinate fasciculus (UF). After Bonferroni correction, there were no correlations between the FA, MD, AD and RD values and the clinical characteristics of patients with NDPH (p > 0.05/96). CONCLUSION The results of our research indicated that patients with NDPH might have widespread abnormalities in the white matter of the brain.
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Affiliation(s)
- Yanliang Mei
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Wei Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Dong Qiu
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Ziyu Yuan
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xiaoyan Bai
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, Neurosurgical Institute, Beijing, China
| | - Hefei Tang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Peng Zhang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xue Zhang
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, Neurosurgical Institute, Beijing, China
| | - Yaqing Zhang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xueying Yu
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
| | - Yonggang Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
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11
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Zhang X, Wang W, Zhang X, Bai X, Yuan Z, Zhang P, Bai R, Jiao B, Zhang Y, Li Z, Tang H, Zhang Y, Yu X, Wang Y, Sui B. Normal glymphatic system function in patients with new daily persistent headache using diffusion tensor image analysis along the perivascular space. Headache 2023; 63:663-671. [PMID: 37140029 DOI: 10.1111/head.14514] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To investigate the glymphatic function in patients with new daily persistent headache (NDPH) using the diffusion tensor image analysis along the perivascular space (DTI-ALPS) method. BACKGROUND NDPH, a rare and treatment-refractory primary headache disorder, is poorly understood. There is limited evidence to suggest that headaches are associated with glymphatic dysfunction. Thus far, no studies have evaluated glymphatic function in patients with NDPH. METHODS In this cross-sectional study conducted in the Headache Center of Beijing Tiantan Hospital, patients with NDPH and healthy controls were enrolled. All participants underwent brain magnetic resonance imaging examinations. Clinical characteristics and neuropsychological evaluation were examined in patients with NDPH. ALPS indexes for both hemispheres were measured to determine the glymphatic system function in patients with NDPH and healthy controls. RESULTS In total, 27 patients with NDPH (14 males, 13 females; age [mean ± standard deviation (SD)]: 36.6 ± 20.6) and 33 healthy controls (15 males, 18 females; age [mean ± SD]: 36.0 ± 10.8) were included in the analysis. No significant differences between groups were observed in the left ALPS index (1.583 ± 0.182 vs. 1.586 ± 0.175, mean difference = 0.003, 95% confidence interval [CI] of difference = -0.089 to 0.096, p = 0.942), or right ALPS index (1.578 ± 0.230 vs. 1.559 ± 0.206, mean difference = -0.027, 95% CI of difference = -0.132 to 0.094, p = 0.738). Additionally, ALPS indexes were not correlated with clinical characteristics or neuropsychiatric scores. CONCLUSION No glymphatic dysfunction was detected in patients with NDPH by means of the ALPS method. Additional studies with larger samples are needed to confirm these preliminary findings and improve the understanding of glymphatic function in NDPH.
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Affiliation(s)
- Xue Zhang
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xueyan Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoyan Bai
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ziyu Yuan
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ruiliang Bai
- Department of Physical Medicine and Rehabilitation of the Affiliated Sir Run Shumen Shaw Hospital and Interdisciplinary Institute of Neuroscience and Technology, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Biomedical Engineering of Education Ministry, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
- MOE Frontier Science Center for Brain Science and Brain-Machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, China
| | - Bingjie Jiao
- Key Laboratory of Biomedical Engineering of Education Ministry, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Yingkui Zhang
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhiye Li
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hefei Tang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yaqing Zhang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xueying Yu
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yonggang Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
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12
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Wang W, Yuan Z, Zhang X, Bai X, Tang H, Mei Y, Qiu D, Zhang Y, Zhang P, Zhang X, Zhang Y, Yu X, Sui B, Wang Y. Mapping the aberrant brain functional connectivity in new daily persistent headache: a resting-state functional magnetic resonance imaging study. J Headache Pain 2023; 24:46. [PMID: 37098469 PMCID: PMC10131335 DOI: 10.1186/s10194-023-01577-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/13/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND AND PURPOSE The pathogenesis of new daily persistent headache (NDPH) is not fully understood. We aim to map aberrant functional connectivity (FC) in patients with NDPH using resting-state functional magnetic resonance imaging (MRI). METHODS Brain structural and functional MRI data were acquired from 29 patients with NDPH and 37 well-matched healthy controls (HCs) in this cross-sectional study. Region of interest (ROI) based analysis was used to compare FC between patients and HCs, with 116 brain regions in the automated anatomical labeling (AAL) atlas were defined as seeds. The correlations between aberrant FC and patients' clinical characteristics, and neuropsychological evaluation were also investigated. RESULTS Compared with HCs, patients with NDPH showed increased FC in the left inferior occipital gyrus, right thalamus and decreased FC in right lingual gyrus, left superior occipital gyrus, right middle occipital gyrus, left inferior occipital gyrus, right inferior occipital gyrus, right fusiform gyrus, left postcentral gyrus, right postcentral gyrus, right thalamus and right superior temporal gyrus. There were no correlation between FC of these brain regions and clinical characteristics, neuropsychological evaluation after Bonferroni correction (p > 0.05/266). CONCLUSIONS Patients with NDPH showed aberrant FC in multiple brain regions involved in perception and regulation of emotion and pain. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05334927.
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Affiliation(s)
- Wei Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Ziyu Yuan
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xueyan Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Xiaoyan Bai
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, 100070, China
| | - Hefei Tang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yanliang Mei
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Dong Qiu
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yingkui Zhang
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Peng Zhang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xue Zhang
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, 100070, China
| | - Yaqing Zhang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xueying Yu
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.
| | - Yonggang Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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13
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Navis A. A Review of Neurological Symptoms in Long COVID and Clinical Management. Semin Neurol 2023. [PMID: 37068519 DOI: 10.1055/s-0043-1767781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Long COVID is a clinical diagnosis generally referring to the persistence or development of new symptoms, affecting multiple organ systems after SARS-CoV-2 COVID-19 infection. Long COVID is thought to affect ∼20% of people after infection, including all age ranges and severity of infection. Fatigue, postexertional malaise, and respiratory and cardiac symptoms are commonly described. Neurological symptoms such as cognitive changes, sensory disturbances, headaches, and dysautonomia are common as well. The underlying pathophysiology remains unclear but immune dysregulation, autoimmunity, persistent viral reservoirs, and microvascular dysfunction have been implicated. As there are no tests at this time to diagnose long COVID, work-up should be focused on assessing reversible or treatable causes of symptoms. Furthermore, no treatments for long COVID currently exist, and management remains focused on a multimodal approach and symptom management, with many people showing improvement in symptoms over time.
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Affiliation(s)
- Allison Navis
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
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14
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Thomas DC, Eliav E, Garcia AR, Fatahzadeh M. Systemic Factors in Temporomandibular Disorder Pain. Dent Clin North Am 2023; 67:281-298. [PMID: 36965931 DOI: 10.1016/j.cden.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The science of temporomandibular disorder (TMD) pain and its management has gone through significant changes during the last several decades. The authors strongly feel that the effect of systemic factors influencing TMD pain has been largely overlooked and poorly accounted for, even in established pain-management programs and protocols. The hope is that this article will act as a wake-up call for the pain management community to consider the importance of adequate knowledge of the systemic factors that affect the experience of TMD pain by the patient.
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Affiliation(s)
- Davis C Thomas
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ 07103, USA; Eastman Institute of Oral Health, Rochester, NY, USA.
| | - Eli Eliav
- Eastman Institute for Oral Health, University of Rochester Medical Center, 625 Elmwood Avenue, Rochester, NY 14620, USA
| | - Antonio Romero Garcia
- CranioClinic, Valencia and Dental Sleep Solutions, Plaza San Agustin, Portal C, Piso 2, Puerta 2, Valencia 46002, Spain
| | - Mahnaz Fatahzadeh
- Division of Oral Medicine, Department of Oral Medicine, Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ 07103, USA
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15
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New-onset headache following COVID-19: An Italian multicentre case series. J Neurol Sci 2023; 446:120591. [PMID: 36807975 PMCID: PMC9931424 DOI: 10.1016/j.jns.2023.120591] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To describe the characteristics of patients with new-onset headache following SARS-CoV-2 infection. BACKGROUND SARS-CoV-2 infection leads to several neurological manifestations, and headache is a frequent and disabling symptom, both exacerbating pre-existing headache syndromes and causing new-onset ones. METHODS Patients with new-onset headache after SARS-CoV-2 infection with consent to participate were included, while those ones with previous headaches were excluded. The temporal latency of headache after infection, pain characteristics, and concomitant symptoms were analysed. Moreover, the efficacy of acute and preventive medications was explored. RESULTS Eleven females (median age 37.0 [10.0-60.0] years old) were included. In most cases, headache onset occurred with the infection, the location of pain varied, and the quality was either pulsating or tightening. Headache was persistent and daily in 8 patients (72.7%), while it occurred in episodes in the remaining subjects. Baseline diagnoses were new daily persistent headache (36.4%), probable new daily persistent headache (36.4%), probable migraine (9.1%), and migraine-like headache secondary to COVID-19 (18.2%). Ten patients received one or more preventive treatments and six of them showed an improvement. CONCLUSION New-onset headache following COVID-19 is a heterogenous condition with uncertain pathogenesis. This type of headache can become persistent and severe, with a wide spectrum of manifestations (new daily persistent headache being the most represented one) and variable response to treatment.
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16
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Zhang X, Wang W, Bai X, Mei Y, Tang H, Yuan Z, Zhang X, Li Z, Zhang P, Hu Z, Zhang Y, Yu X, Sui B, Wang Y. Alterations in regional homogeneity and multiple frequency amplitudes of low-frequency fluctuation in patients with new daily persistent headache: a resting-state functional magnetic resonance imaging study. J Headache Pain 2023; 24:14. [PMID: 36814220 PMCID: PMC9946707 DOI: 10.1186/s10194-023-01543-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/02/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND New daily persistent headache (NPDH) is a rare primary headache that is highly disabling. The pathophysiology of NDPH is still unclear, and we aimed to reveal the underlying mechanism of NDPH through functional magnetic resonance imaging (fMRI) analysis. METHODS In this cross-sectional study, thirty patients with NDPH and 30 healthy controls (HCs) were recruited. The blood oxygen level-dependent (BOLD) sequences of all participants were obtained using the GE 3.0 T system. We performed ReHo, ALFF (conventional band: 0.01-0.08 Hz, slow-5: 0.01-0.027 Hz, slow-4: 0.027-0.073 Hz) and seed-based to the whole brain functional connectivity (FC) analysis in the NDPH and HC groups. The sex difference analysis of ReHo, ALFF, and FC values was conducted in the NDPH group. We also conducted Pearson's correlation analysis between ReHo, ALFF, FC values and clinical characteristics (pain intensity, disease duration, HIT-6, GAD-7, PHQ-9, and PSQI scores). RESULTS Both increased ReHo (PFWE-corr = 0.012) and ALFF values (0.01-0.08 Hz, PFWE-corr = 0.009; 0.027-0.073 Hz, PFWE-corr =0.044) of the left middle occipital gyrus (MOG_L) were found in the NDPH group compared to the HC group. There was no significant difference in FC maps between the two groups. Compared to the HC group, no difference was found in ReHo (p = 0.284), ALFF (p = 0.246), and FC (p = 0.118) z scores of the MOG_L in the NDPH group. There was also no sex difference in ReHo (p = 0.288), ALFF (p = 0.859), or FC z score (p = 0.118) of the MOG_L in patients with NDPH. There was no correlation between ReHo, ALFF, FC z scores and clinical characteristics after Bonferroni correction (p < 0.05/18). CONCLUSIONS Patients with NDPH may have abnormal activation of the visual system. Abnormal visual activation may occur mainly in higher frequency band of the classical band. No sex differences in brain activity were found in patients with NDPH.
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Affiliation(s)
- Xueyan Zhang
- grid.412633.10000 0004 1799 0733Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, China
| | - Wei Wang
- grid.24696.3f0000 0004 0369 153XHeadache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Bai
- grid.411617.40000 0004 0642 1244Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China ,grid.411617.40000 0004 0642 1244Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, China
| | - Yanliang Mei
- grid.24696.3f0000 0004 0369 153XHeadache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hefei Tang
- grid.24696.3f0000 0004 0369 153XHeadache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ziyu Yuan
- grid.24696.3f0000 0004 0369 153XHeadache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xue Zhang
- grid.411617.40000 0004 0642 1244Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China ,grid.411617.40000 0004 0642 1244Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, China
| | - Zhiye Li
- grid.411617.40000 0004 0642 1244Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China ,grid.411617.40000 0004 0642 1244Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, China
| | - Peng Zhang
- grid.24696.3f0000 0004 0369 153XHeadache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Yaqing Zhang
- grid.24696.3f0000 0004 0369 153XHeadache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xueying Yu
- grid.24696.3f0000 0004 0369 153XHeadache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Yonggang Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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17
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Patterson Gentile C, Aguirre GK, Hershey AD, Szperka CL. Comparison of continuous headache features in youth with migraine, new daily persistent headache, and persistent post-traumatic headache. Cephalalgia 2023; 43:3331024221131331. [PMID: 36587297 PMCID: PMC10029693 DOI: 10.1177/03331024221131331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To compare clinical features in youth with continuous headache from migraine, persistent post-traumatic headache, and new daily persistent headache to determine if they are similar, contrary to their distinction in the International Classification of Headache Disorders. METHODS We pursued a single center age- and sex-matched observational study comparing the clinical characteristics of 150 youth (11 - 17 years old) with continuous headache from migraine, persistent post-traumatic headache, and new daily persistent headache. A diagnostic algorithm based on international classification of headache disorders criteria was used to identify those with migraine (headache features of migraine with gradual onset), and persistent post-traumatic headache and new daily persistent headache (based on the circumstances of headache onset regardless of headache features). Fifty participants each with migraine, persistent post-traumatic headache, and new daily persistent headache were matched by age and sex. Participant survey responses on headache characteristics were compared. RESULTS Median usual headache severity was 6.0 [95%CI 6.0, 6.0] and was not different across diagnostic groups (H statistic = 1.2, p = 0.55). Headache exacerbation frequency, disability, associated symptoms, and most triggers were not significantly different across groups. The majority of persistent post-traumatic headache and new daily persistent headache had headache features consistent with a diagnose of migraine (72% and 62%, respectively). CONCLUSION Our findings suggest that most persistent post-traumatic headache and new daily persistent headache may represent abrupt onset of migraine.
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Affiliation(s)
- Carlyn Patterson Gentile
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Geoffrey K Aguirre
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Andrew D Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Christina L Szperka
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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18
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Bai X, Wang W, Zhang X, Hu Z, Zhang Y, Li Z, Zhang X, Yuan Z, Tang H, Zhang Y, Yu X, Zhang P, Wang Y, Sui B. Cerebral perfusion variance in new daily persistent headache and chronic migraine: an arterial spin-labeled MR imaging study. J Headache Pain 2022; 23:156. [PMID: 36482334 PMCID: PMC9733035 DOI: 10.1186/s10194-022-01532-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE New daily persistent headache (NDPH) and chronic migraine (CM) are two different types of headaches that might involve vascular dysregulation. There is still a lack of clarity about altered brain perfusion in NDPH and CM. This study aimed to investigate the cerebral perfusion variances of NDPH and CM using multi-delay pseudo-continuous arterial spin-labeled magnetic resonance imaging (pCASL-MRI). METHODS Fifteen patients with NDPH, 18 patients with CM, and 15 age- and sex-matched healthy controls (HCs) were included. All participants underwent 3D multi-delay pCASL-MRI to obtain cerebral perfusion data, including arrival-time-corrected cerebral blood flow (CBF) and arterial cerebral blood volume (aCBV). The automated anatomical labeling atlas 3 (AAL3) was used to parcellate 170 brain regions. The CBF and aCBV values in each brain region were compared among the three groups. Correlation analyses between cerebral perfusion parameters and clinical variables were performed. RESULTS Compared with HC participants, patients with NDPH were found to have decreased CBF and aCBV values in multiple regions in the right hemisphere, including the right posterior orbital gyrus (OFCpost.R), right middle occipital gyrus (MOG.R), and ventral anterior nucleus of right thalamus (tVA.R), while patients with CM showed increased CBF and aCBV values presenting in the ventral lateral nucleus of left thalamus (tVL.L) and right thalamus (tVL.R) compared with HCs (all p < 0.05). In patients with NDPH, after age and sex adjustment, the increased aCBV values of IFGorb. R were positively correlated with GAD-7 scores; and the increased CBF and aCBV values of tVA.R were positively correlated with disease duration. CONCLUSION The multi-delay pCASL technique can detect cerebral perfusion variation in patients with NDPH and CM. The cerebral perfusion changes may suggest different variations between NDPH and CM, which might provide hemodynamic evidence of these two types of primary headaches.
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Affiliation(s)
- Xiaoyan Bai
- grid.411617.40000 0004 0642 1244Tiantan Neuroimaging Center for Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China ,grid.411617.40000 0004 0642 1244Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Wei Wang
- grid.411617.40000 0004 0642 1244Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Xueyan Zhang
- grid.412633.10000 0004 1799 0733Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, Henan Province, 450000 China
| | - Zhangxuan Hu
- GE Healthcare, No.1 Tongji Nan Road, Beijing Economic Technological Development Area, Beijing, 100176 China
| | - Yingkui Zhang
- grid.411617.40000 0004 0642 1244Tiantan Neuroimaging Center for Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Zhiye Li
- grid.411617.40000 0004 0642 1244Tiantan Neuroimaging Center for Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China ,grid.411617.40000 0004 0642 1244Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Xue Zhang
- grid.411617.40000 0004 0642 1244Tiantan Neuroimaging Center for Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China ,grid.411617.40000 0004 0642 1244Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Ziyu Yuan
- grid.411617.40000 0004 0642 1244Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Hefei Tang
- grid.411617.40000 0004 0642 1244Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Yaqing Zhang
- grid.411617.40000 0004 0642 1244Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Xueying Yu
- grid.411617.40000 0004 0642 1244Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Peng Zhang
- grid.411617.40000 0004 0642 1244Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Yonggang Wang
- grid.411617.40000 0004 0642 1244Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Binbin Sui
- grid.411617.40000 0004 0642 1244Tiantan Neuroimaging Center for Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
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19
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Patniyot I, Qubty W. Headache in Adolescents. Neurol Clin 2022; 41:177-192. [DOI: 10.1016/j.ncl.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Begasse de Dhaem O, Rizzoli P. Refractory Headaches. Semin Neurol 2022; 42:512-522. [DOI: 10.1055/s-0042-1757925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractMedication overuse headache (MOH), new daily persistent headache (NDPH), and persistent refractory headache attributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection represent a significant burden in terms of disability and quality of life, and a challenge in terms of definition, pathophysiology, and treatment. Regarding MOH, prevention without withdrawal is not inferior to prevention with withdrawal. Preventive medications like topiramate, onabotulinumtoxinA, and calcitonin gene-related peptide (CGRP) monoclonal antibodies improve chronic migraine with MOH regardless of withdrawal. The differential diagnosis of NDPH is broad and should be carefully examined. There are no guidelines for the treatment of NDPH, but options include a short course of steroids, nerve blocks, topiramate, nortriptyline, gabapentin, CGRP monoclonal antibodies, and onabotulinumtoxinA. The persistence of headache 3 months after SARS-CoV2 infection is a predictor of poor prognosis.
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Affiliation(s)
- Olivia Begasse de Dhaem
- Headache Specialist at Hartford HealthCare, Hartford, Connecticut
- Department of Neurology at the University of Connecticut, Milford, Connecticut
| | - Paul Rizzoli
- Department of Neurology, Brigham and Women's Faulkner Hospital J Graham Headache Center, Boston, Massachusetts
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21
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Szabo E, Chang YC, Shulman J, Sieberg CB, Sethna NF, Borsook D, Holmes SA, Lebel AA. Alterations in the structure and function of the brain in adolescents with new daily persistent headache: A pilot
MRI
study. Headache 2022; 62:858-869. [DOI: 10.1111/head.14360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/29/2022] [Accepted: 06/03/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Edina Szabo
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry and Behavioral Sciences Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
| | | | - Julie Shulman
- Department of Physical Therapy and Occupational Therapy Boston Children's Hospital Boston Massachusetts USA
| | - Christine B. Sieberg
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry and Behavioral Sciences Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
- Department of Psychiatry Harvard Medical School Boston Massachusetts USA
| | - Navil F. Sethna
- Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital Boston Massachusetts USA
| | - David Borsook
- Department of Psychiatry Massachusetts General Hospital Boston Massachusetts USA
- Department of Radiology Massachusetts General Hospital Boston Massachusetts USA
- Department of Anesthesiology Harvard Medical School Boston Massachusetts USA
| | - Scott A. Holmes
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
- Pediatric Pain Pathway Lab, Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
| | - Alyssa A. Lebel
- Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital Boston Massachusetts USA
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22
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Abstract
Pain is a complex term that describes various sensations that create discomfort in various ways or types inside the human body. Generally, pain has consequences that range from mild to severe in different organs of the body and will depend on the way it is caused, which could be an injury, illness or medical procedures including testing, surgeries or therapies, etc. With recent advances in artificial-intelligence (AI) systems associated in biomedical and healthcare settings, the contiguity of physician, clinician and patient has shortened. AI, however, has more scope to interpret the pain associated in patients with various conditions by using any physiological or behavioral changes. Facial expressions are considered to give much information that relates with emotions and pain, so clinicians consider these changes with high importance for assessing pain. This has been achieved in recent times with different machine-learning and deep-learning models. To accentuate the future scope and importance of AI in medical field, this study reviews the explainable AI (XAI) as increased attention is given to an automatic assessment of pain. This review discusses how these approaches are applied for different pain types.
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23
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Sampaio Rocha‐Filho PA. Headache associated with COVID‐19: Epidemiology, characteristics, pathophysiology, and management. Headache 2022; 62:650-656. [PMID: 35545780 PMCID: PMC9348060 DOI: 10.1111/head.14319] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/04/2022] [Indexed: 12/14/2022]
Abstract
Objective Background Method Results Conclusions
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Affiliation(s)
- Pedro Augusto Sampaio Rocha‐Filho
- Division of Neuropsychiatry Centro de Ciências Médicas Universidade Federal de Pernambuco (UFPE) Recife Brazil
- Hospital Universitario Oswaldo Cruz Universidade de Pernambuco Recife Brazil
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24
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Neurological and Psychiatric Symptoms of COVID-19: A Narrative Review. PSYCHIATRY INTERNATIONAL 2022. [DOI: 10.3390/psychiatryint3020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recently dubbed Long COVID or Long-Haul COVID, those recovering from the initial COVID-19 infection may maintain clinical signs for longer than two or more weeks following the initial onset of the infection. The virus can gain entry into the CNS through axonal transport mediated through the olfactory nerve or hematogenous spread and can also cross the blood–brain barrier to access the temporal lobe and the brainstem. The neurologic and neuropsychiatric symptoms associated with COVID-19 patients are becoming a highly studied area due to the increased frequency of reported cases. Multiple hospital case series and observational studies have found a headache to be a common symptom among patients who are symptomatic with the SARS-CoV-2 virus. The headache described by many of these patients is similar to new daily persistent headache (NDPH). NDPH potentially develops in response to pro-inflammatory cytokines during a persistent systemic or CNS inflammation, mostly due to the initial infection. The treatments investigated were high-dose steroids, tetracycline derivatives, onabotulinum toxin type A, and long-term multidrug regimens. Among the identified symptoms of post-COVID-19 viral illness, fatigue appears to be the most ubiquitous. High-dose vitamin C is currently a suggested therapy proposed for its antioxidant, anti-inflammatory, and immunomodulatory properties. The mental health consequences of this diagnosis are being identified among large portions of COVID-19 survivors. Among these consequences, cases of major depressive disorder (MDD) and anxiety are being reported and closely examined. The aim of this narrative review is to highlight the neurological and psychiatric symptoms that have been associated with Long-Haul COVID and their possible treatments.
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25
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Cocores AN, Monteith TS. Headache as a Neurologic Manifestation of Systemic Disease. Curr Treat Options Neurol 2022; 24:17-40. [PMID: 35317303 PMCID: PMC8931180 DOI: 10.1007/s11940-022-00704-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/26/2022]
Abstract
Purpose of Review Recent Findings Summary
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Affiliation(s)
- Alexandra N. Cocores
- Division of Headache, Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW 14 Street, Florida, Miami 33132 USA
| | - Teshamae S. Monteith
- Division of Headache, Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW 14 Street, Florida, Miami 33132 USA
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26
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The Enigma of New Daily Persistent Headache: What Solutions for Pediatric Age? Curr Pain Headache Rep 2022; 26:165-172. [DOI: 10.1007/s11916-022-01011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/03/2022]
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27
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Membrilla JA, Caronna E, Trigo-López J, González-Martínez A, Layos-Romero A, Pozo-Rosich P, Guerrero-Peral Á, Gago-Veiga AB, Andrés-López A, Díaz de Terán J. Persistent headache after COVID-19: Pathophysioloy, clinic and treatment. NEUROLOGY PERSPECTIVES 2021; 1:S31-S36. [PMID: 38620971 PMCID: PMC8669731 DOI: 10.1016/j.neurop.2021.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/03/2021] [Accepted: 10/12/2021] [Indexed: 12/17/2022]
Abstract
SARS-CoV-2 is the virus responsible for the COVID-19 pandemic. The acute infection is characterised not only by respiratory symptoms, but also by multiple systemic manifestations, including neurological symptoms. Among these, headache is a frequent complaint. As the pandemic progresses and the population of patients recovering from COVID-19 grows, it is becoming apparent that the headache present in the acute stage of the infection may persist for an indeterminate period, becoming a major problem for the patient and potentially leading to disability. In this review we describe the pathophysiological and clinical aspects of persistent headache after COVID-19 based on the information currently available in the literature and the authors' clinical experience.
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Affiliation(s)
- J A Membrilla
- Unidad de Cefaleas Complejas y Dolor Neuropático, Servicio de Neurología, Hospital Universitario La Paz, Madrid, Spain
| | - E Caronna
- Servicio de Neurología, Hospital Universitario Vall d'Hebron, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
- Grupo de Investigación en Cefalea y Dolor Neurológico, Instituto de Investigación Vall d'Hebron, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J Trigo-López
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A González-Martínez
- Hospital Universitario de La Princesa e Instituto de Investigación Sanitaria La Princesa, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Layos-Romero
- Hospital General Universitario de Albacete, Albacete, Spain
| | - P Pozo-Rosich
- Servicio de Neurología, Hospital Universitario Vall d'Hebron, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
- Grupo de Investigación en Cefalea y Dolor Neurológico, Instituto de Investigación Vall d'Hebron, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Á Guerrero-Peral
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A B Gago-Veiga
- Hospital Universitario de La Princesa e Instituto de Investigación Sanitaria La Princesa, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - J Díaz de Terán
- Unidad de Cefaleas Complejas y Dolor Neuropático, Servicio de Neurología, Hospital Universitario La Paz, Madrid, Spain
- Instituto de Investigación Biosanitaria del Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
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28
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Dhand UK. New Daily Persistent Headache-like Presentation Triggered by a Sudden Head Drop in a Patient With Myasthenia Gravis. Neurol Clin Pract 2021; 11:e773-e774. [PMID: 34840906 DOI: 10.1212/cpj.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/07/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Upinder K Dhand
- Tennova Neurology and University of Tennessee Graduate School of Medicine, Knoxville TN
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29
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Evans RW, Turner DP. Clinical features of new daily persistent headache: A retrospective chart review of 328 cases. Headache 2021; 61:1529-1538. [PMID: 34710236 DOI: 10.1111/head.14207] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe the clinical features of new daily persistent headache (NDPH) at an outpatient neurology clinic with a subspecialty interest in headache in Houston, Texas. METHODS A retrospective chart review was performed by a neurologist subspecialty certified in headache medicine of all patients seen from September 1, 2011 through February 28, 2020 (8.5 years) with a provisional diagnosis of NDPH and abstracted charts meeting criteria for primary NDPH. RESULTS A total of 328 patients met the International Classification of Headache Disorders, 3rd edition criteria including 215 (65.5%) female patients. The mean age of onset was 40.3 years (range 12-87 years) with a mean age at first consultation in the study clinic of 42.6 years (range 12-87 years). The median [25th, 75th] duration of NDPH at initial consultation was 0.7 [0.3, 2.0] years, and at last visit, it was 1.9 [0.7, 4.8] years. The headaches were side-locked unilateral in 28/328 (8.5%). 12/328 cases (3.6%) with a thunderclap onset are reported. There was no obvious seasonal or other cyclical variation. The pain was usually moderate to severe and more often severe for the migraine phenotype (MP; 260/328 [79.3%] of cases) than for the tension-type phenotype (TTP). Precipitating factors were the following: stressful life events, 67/328 (20.4%); upper respiratory infection or flu-like illness, 33/328 (10.1%); and extracranial surgery, 5/328 (1.5%). Exacerbating or aggravating factors similar to migraine triggers were more often reported with the MP than with the TTP in this sample. For the MP, vertigo or dizziness was reported by 19/260 (7.3%) and a visual aura by 21/260 (8.1%) with descriptions provided. The prognostic types were the following for all patients: persisting (refractory), 305/328 (93.0%); relapsing-remitting, 9/328 (2.7%); and remitting (self-limited), 14/328 (4.3%). CONCLUSION NDPH is typically of moderate to severe intensity often with migraine features without obvious seasonal or other cyclical variation. Most cases are refractory. 3.6% have a thunderclap onset often with a good response to treatment.
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Affiliation(s)
- Randolph W Evans
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Dana P Turner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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30
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Lobo R, Wang M, Lobo S, Bahra A. Time to retire 'New daily persistent headache': Mode of onset of chronic migraine and tension-type headache. Cephalalgia 2021; 42:385-395. [PMID: 34579562 DOI: 10.1177/03331024211044440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
New daily persistent headache is described as an enigmatic condition with daily headache from onset. It has posed challenges diagnostically and therapeutically.Methods: We conducted a study of patients referred to headache services based in Central and North-East London, United Kingdom, meeting the International Classificaiton of Headache Disorders - 3 criteria for New daily persistent headache. Information on demographics, phenotype and treatment responses were collected. The syndrome of the daily headache was also classified according any other ICHD-3-defined syndrome.Results: Of 162 patients, females comprised 68.5% with median age of onset 35 years. The daily headache experienced was chronic migraine in 89.7% and tension-type headache in 8.8%. Thunderclap-onset New daily persistent headache occurred in 14.8%. More than one headache syndrome was experienced in 15.4%, including cough, hypnic, sexual and stabbing headache. All aura types were experienced, most commonly brainstem aura in 39%. Prior headache was reported 53.7%. A persisting sub-form was present in 51.2%, relapsing remitting in 12.3% and 14.0% reported improvement; 19.8% were lost to follow-up. Only 11.1% reported an antecedent trigger. The most common premorbid disorders were psychiatric in 35.7%. A fifth improved on preventative medication, most commonly amitriptyline, propranolol and topiramate.Conclusion: Our cohort of New daily persistent headache is consistent with a mode of onset of migraine and tension-type headache which occurs in predisposed individuals.
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Affiliation(s)
- Rhannon Lobo
- National Hospital for Neurology and Neurosurgery, 98546National Hospital for Neurology and Neurosurgery, London, UK
| | - Mu Wang
- Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, 030012, Shanxi Province, China.,Section for Nutrition Research, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, 4615Imperial College London, Imperial College London, London, UK
| | - Sean Lobo
- Faculty of Life Science and Medicine, King's College London, London, UK
| | - Anish Bahra
- National Hospital for Neurology and Neurosurgery, 98546National Hospital for Neurology and Neurosurgery, London, UK.,Department of Neurology, 9744Barts Health NHS Trust, Whipps Cross Hospital, London, UK
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31
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Strong E, Pierce EL, Langdon R, Strelzik J, McClintock W, Cameron M, Furda M, DiSabella M. New Daily Persistent Headache in a Pediatric Population. J Child Neurol 2021; 36:888-893. [PMID: 34048280 DOI: 10.1177/08830738211004514] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION New daily persistent headache (NDPH) is a primary headache disorder characterized by an intractable, daily, and unremitting headache lasting for at least 3 months. Currently, there are limited studies in the pediatric population describing the characteristics of NDPH. OBJECTIVE The objective of the current study is to describe the characteristics of NDPH in pediatric patients presenting to a headache program at a tertiary referral center. METHODS The participants in the current study were pediatric patients who attended the Headache Clinic at Children's National Hospital between 2016 and 2018. All patients seen in the Headache Clinic were enrolled in an institutional review board-approved patient registry. RESULTS Between 2016 and 2018, NDPH was diagnosed in 245 patients, representing 14% of the total headache population. NDPH patients were predominantly female (78%) and white (72%). The median age was 14.8 years. The median pain intensity was 6 of 10 (standard deviation = 1.52). Most patients reported experiencing migrainous features, namely, photophobia (85%), phonophobia (85%), and a reduced activity level (88%). Overall, 33% of patients had failed at least 1 preventive medication, and 56% had failed at least 1 abortive medication. Furthermore, 36% of patients were additionally diagnosed with medication overuse headache. CONCLUSION NDPH is a relatively frequent disorder among pediatric chronic headache patients. The vast majority of these patients experience migrainous headache characteristics and associated symptoms and are highly refractory to treatment-as evidenced by a strong predisposition to medication overuse headache and high rates of failed preventive management.
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Affiliation(s)
- Eric Strong
- 8404Children's National Hospital, Washington, DC, USA
| | | | | | | | | | - Mark Cameron
- 8404Children's National Hospital, Washington, DC, USA
| | - Mary Furda
- 8404Children's National Hospital, Washington, DC, USA
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32
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Altunisik E, Sut SK, Sahin S, Baykan AH. Is Increased Intracranial Pressure a Factor in Persistent Headache After Coronavirus Disease 2019? J Nerv Ment Dis 2021; 209:640-644. [PMID: 34280176 PMCID: PMC8407289 DOI: 10.1097/nmd.0000000000001393] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT This study aimed to determine pain characteristics in patients with persistent headache after COVID-19 and to investigate the role of increased intracranial pressure (ICP) in the pathogenesis of this headache. This is a case-control study comparing the parameters and measurements indicating increased ICP based on magnetic resonance imaging between COVID-19-diagnosed patients with persistent headache and a control group. Optic nerve sheath diameter (ONSD) and eyeball transverse diameter (ETD) were performed on the left eye of each participant. Seventeen of the patients (53.12%) met the diagnostic criteria for new daily persistent headache. Seven patients (21.87%) had migraine, and eight (25%) had tension headache characteristics. No significant difference was observed between the patient and control groups in terms of the ONSD and ETD values. It is possible that the etiopathogenesis is multifactorial. We consider that future studies that will evaluate ICP measurements in large patient groups can present a different perspective for this subject.
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Affiliation(s)
| | - Suat Kamil Sut
- Radiology, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
| | - Sukru Sahin
- Radiology, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
| | - Ali Haydar Baykan
- Radiology, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
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33
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Palacios-Ceña D, Talavera B, Gómez-Mayordomo V, Garcia-Azorin D, Gallego-Gallego M, Cuadrado ML, Guerrero-Peral ÁL. Understanding the diagnoses and medical care experience of patients with new daily persistent headache: a qualitative study in Spain. BMJ Open 2021; 11:e048552. [PMID: 34404708 PMCID: PMC8372810 DOI: 10.1136/bmjopen-2020-048552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To explore the experiences of patients suffering from new daily persistent headache (NDPH) regarding the diagnostic process, treatment and medical care. DESIGN A qualitative phenomenological study was conducted. SETTING A specialised headache unit at two university hospitals in Spain between February 2017 and December 2018. PARTICIPANTS Patients diagnosed with NDPH according to the International Classification of Headache disorders (third beta edition). METHODS Purposeful sampling was performed. Data were collected using unstructured and semistructured interviews, researchers' field notes and patients' drawings. An inductive thematic analysis was used to identify significant emerging themes from interviews, field notes and descriptions of patients' drawings. Also, Guillemin's proposal was used to analyse the contents of drawings. RESULTS Nineteen patients with a mean age of 45.3 were recruited. Four main themes emerged: (1) Seeking a diagnosis, patients visit many doctors without receiving a clear answer and their diagnosis is delayed; (2) Self-medication-minimising pill intake, medication is ineffective, and therefore, some patients discontinue treatment, or are flexible with how they take medication; (3) Trying other non-pharmacological options, many patients turn to other therapies and complementary and/or alternative therapies as a second option, however these are ineffective and (4) Medical care, with two subthemes, referrals and lacking continuity of care, and building the doctor-patient relationship. Patients describe how the referral breaks the continuity of care, and how they identify the traits of a doctor who is approachable and which behaviours the doctor should avoid when caring for patients. CONCLUSIONS An in-depth knowledge of the beliefs and expectations of patients with NDPH will allow the professional to establish a relationship of trust, which will improve the patients' knowledge of which therapies are the most appropriate, and to establish expectations based on the relationship with the doctor, and not only on patients' beliefs.
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Affiliation(s)
- Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón/Madrid, Spain
- Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos, Alcorcón/ Madrid, Spain
| | - Blanca Talavera
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Víctor Gómez-Mayordomo
- Department of Neurology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - David Garcia-Azorin
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - María Luz Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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34
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Dono F, Consoli S, Evangelista G, D'Apolito M, Russo M, Carrarini C, Calisi D, De Rosa M, Di Pietro M, De Angelis MV, Travaglini D, Sensi SL, Onofrj M, Bonanni L. New daily persistent headache after SARS-CoV-2 infection: a report of two cases. Neurol Sci 2021; 42:3965-3968. [PMID: 34264414 PMCID: PMC8280630 DOI: 10.1007/s10072-021-05444-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/26/2021] [Indexed: 01/12/2023]
Abstract
Background The 2019 Coronavirus (SARS-CoV-2) is a novel respiratory virus which causes Coronavirus Disease19 (COVID-19). Although the predominant clinical picture of COVID-19 is represented by respiratory symptoms, neurological manifestations are being increasingly recognized. Headache, in particular migraine-like and tension types, has been largely reported in patients suffering from COVID-19 both in the acute and the healing phase of the infection. New daily persistent headache (NDPH) is a primary headache characterized by persistent and daily painful symptoms, with pain becoming continuous and non-remitting within 24 h, and lasting more than 3 months. Even though an increasing number of reports describe patients who develop a persistent headache, diagnosis of NPDH has been rarely explored in the context of COVID-19. Methods Two patients with persistent headache and Sars-CoV-2 infection were identified. Both underwent a full clinical and neuroradiological evaluation. Blood sample with inflammatory biomarkers search was also performed. Results According to International Classifications of Headache Disorders diagnosis of probable new daily persistent headache was made. The treatment with high doses of steroids was associated with relief of symptoms. Conclusions Our report described two cases of probable NDPH due to SARS-CoV-2 infection. Clinical evaluation of COVID-19 patients presenting with persistent headache should take into consideration NDPH. Given the supposed major role for neuroinflammation in the genesis of Sars-CoV-2-driven NDPH, immunomodulatory therapy should be promptly started. In line with this hypothesis, we obtained a good therapeutic response to short-term high dose of corticosteroids.
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Affiliation(s)
- Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Stefano Consoli
- Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Maria D'Apolito
- Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Dario Calisi
- Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Matteo De Rosa
- Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Martina Di Pietro
- Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | | | - Daniela Travaglini
- Department of Neurology, Headache Center, SS Annunziata Hospital, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy. .,Department of Neurology, Stroke Unit, SS Annunziata Hospital, Chieti, Italy. .,Department of Neurology, Headache Center, SS Annunziata Hospital, Chieti, Italy.
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Fernández-de-Las-Peñas C, Gómez-Mayordomo V, Cuadrado ML, Palacios-Ceña D, Florencio LL, Guerrero AL, García-Azorín D, Hernández-Barrera V, Arendt-Nielsen L. The presence of headache at onset in SARS-CoV-2 infection is associated with long-term post-COVID headache and fatigue: A case-control study. Cephalalgia 2021; 41:1332-1341. [PMID: 34134526 PMCID: PMC8212025 DOI: 10.1177/03331024211020404] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective To investigate the association of headache during the acute phase of SARS-CoV-2 infection with long-term post-COVID headache and other post-COVID symptoms in hospitalised survivors. Methods A case-control study including patients hospitalised during the first wave of the pandemic in Spain was conducted. Patients reporting headache as a symptom during the acute phase and age- and sex-matched patients without headache during the acute phase participated. Hospitalisation and clinical data were collected from medical records. Patients were scheduled for a telephone interview 7 months after hospital discharge. Participants were asked about a list of post-COVID symptoms and were also invited to report any additional symptom they might have. Anxiety/depressive symptoms and sleep quality were assessed with the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index. Results Overall, 205 patients reporting headache and 410 patients without headache at hospitalisation were assessed 7.3 months (Standard Deviation 0.6) after hospital discharge. Patients with headache at onset presented a higher number of post-COVID symptoms (Incident Rate Ratio: 1.16, 95% CI: 1.03–1.30). Headache at onset was associated with a previous history of migraine (Odd Ratio: 2.90, 95% Confidence Interval: 1.41–5.98) and with the development of persistent tension-type like headache as a new post-COVID symptom (Odd Ratio: 2.65, 95% CI: 1.66–4.24). Fatigue as a long-term symptom was also more prevalent in patients with headache at onset (Odd Ratio: 1.55, 95% CI: 1.07–2.24). No between-group differences in the prevalence of anxiety/depressive symptoms or sleep quality were seen. Conclusion Headache in the acute phase of SARS-CoV-2 infection was associated with higher prevalence of headache and fatigue as long-term post-COVID symptoms. Monitoring headache during the acute phase could help to identify patients at risk of developing long-term post-COVID symptoms, including post-COVID headache.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid. Spain
| | | | - María L Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid. Spain
| | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid. Spain
| | - Angel L Guerrero
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain.,Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | | | - Lars Arendt-Nielsen
- CNAP, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Uniyal R, Chhirolya R, Tripathi A, Mishra P, Paliwal VK. Is new daily persistent headache a fallout of somatization? An observational study. Neurol Sci 2021; 43:541-547. [PMID: 33991261 DOI: 10.1007/s10072-021-05236-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/07/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE New daily persistent headache (NDPH) is characterized by daily, persistent headache with clearly remembered onset, preceding events or triggers and treatment refractoriness of headache. The pathophysiology of NDPH is still unresolved. NDPH has been associated with somatoform disorder (DSM 4 TR). Somatization is characterized by vivid memory, disproportionate and persistent thought about symptoms that may explain many characteristics of NDPH. However, tendency towards somatization has not been studied in NDPH patients. METHODS In this cross-sectional study, we evaluated somatization in NDPH, chronic migraine (CM), and chronic tension type headache (CTTH) by comparing the prevalence of somatic symptom disorder (SSD, DSM-5). We evaluated the past tendencies to somatization by comparing various characteristics of past somatic symptoms (number, duration, type, clearly remembered onset, etc.) between NDPH, CM, and CTTH. RESULTS Forty-seven patients each of NDPH and CTTH and 46 patients of CM were evaluated. Criteria for SSD was fulfilled by 85.1% of NDPH and CTTH patients and only 45.7% of CM. Past history of somatic symptoms was seen in 70% patients with NDPH, 15.2% CM, and 23.4% CTTH (p<0.001). Median number of past somatic symptoms was higher in NDPH. All NDPH patients clearly remembered the onset of at least one past somatic symptom. None of CM and CTTH patients remembered the onset of past somatic symptoms. CONCLUSION NDPH patients displayed significant past history of somatization. Continuation of past tendencies to manifest as NDPH suggests that NDPH may be an epiphenomenon of somatization.
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Affiliation(s)
- Ravi Uniyal
- Department of Neurology, King George's Medical University, Lucknow, India
| | - Rohit Chhirolya
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, India
| | - Prabhakar Mishra
- Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. .,Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India.
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Liu H, Ran Y, Dang L, Yang R, Sun S, Zhang M, Li K, Chen C, Dong Z, Yu S. Clinical features and outcomes of new daily persistent headache in patients in China and comparison with medication overuse headache: a double-center retrospective study. PAIN MEDICINE 2021. [DOI: 10.31636/pmjua.v6i1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: This study examined the clinical features and outcomes of NDPH patients and comparison with medication-overuse headache (MOH) in Mainland China.
Methods: This retrospective study observed patients with NDPH and medication-overuse headache (MOH) visiting two outpatient clinics between November 2011 and December 2019. Clinical information was collected and all patients were followed by telephone.
Results: The study recruited 73 NDPH and 638 MOH patients. The NDPH patients included 39 males (39/73, 53.4%) and 34 females (34/73, 46.6%), with an average age of 37.4 years and average headache duration of 10.6 years. Headache-precipitating factors included infection (11/73, 15.1%) and stress (22/73, 30.1%). Compared to MOH patients, NDPH patients had a male predominance (53.4% vs. 22.6%, p<0.001), younger age of CDH onset (26.7±12.3 vs. 41.4±11.3 years, p<0.001), and longer duration of CDH (10.6±11.8 vs. 6.1±6.2 years, p=0.023). In 62 NDPH patients followed up for 31 months, on average, therapeutic responses were more effective in NDPH patients with trigger factors than in those without trigger factors (71.4% vs. 32.4%; p = 0.002); the odds ratio (OR) of an effective outcome was 5.25 (1.73–17.84, p = 0.005).
Conclusions: NDPH is significantly different from MOH, with a male predominance, younger age of CDH onset, and longer duration of CDH. The presence of trigger factors is an independent predictor of better treatment effect in NDPH patients.
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Abstract
Tension-type headache (TTH) is the most prevalent neurological disorder worldwide and is characterized by recurrent headaches of mild to moderate intensity, bilateral location, pressing or tightening quality, and no aggravation by routine physical activity. Diagnosis is based on headache history and the exclusion of alternative diagnoses, with clinical criteria provided by the International Classification of Headache Disorders, third edition. Although the biological underpinnings remain unresolved, it seems likely that peripheral mechanisms are responsible for the genesis of pain in TTH, whereas central sensitization may be involved in transformation from episodic to chronic TTH. Pharmacological therapy is the mainstay of clinical management and can be divided into acute and preventive treatments. Simple analgesics have evidence-based effectiveness and are widely regarded as first-line medications for the acute treatment of TTH. Preventive treatment should be considered in individuals with frequent episodic and chronic TTH, and if simple analgesics are ineffective, poorly tolerated or contraindicated. Recommended preventive treatments include amitriptyline, venlafaxine and mirtazapine, as well as some selected non-pharmacological therapies. Despite the widespread prevalence and associated disability of TTH, little progress has been made since the early 2000s owing to a lack of attention and resource allocation by scientists, funding bodies and the pharmaceutical industry.
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39
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Evans RW. Primary non-continuous new daily persistent headache: Seven cases and proposed diagnostic criteria. CEPHALALGIA REPORTS 2021. [DOI: 10.1177/2515816321998349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary new daily persistent headache (NDPH) is a rare disorder defined by the third edition of the International Headache Society (ICHD-3) as a continuous and unremitting headache. Non-continuous cases have been reported which do not fit any ICHD-3 criteria. Seven patients are presented who meet all ICHD-3 criteria except for being non-continuous from onset without treatment with a duration of 4 or more hours per day with only one headache per day. The average age of onset was 35.3 years, 57.1% female, and 71.4% had migraine-like features. No cases were unilateral and all cases were persistent without remission. These seven cases constitute a primary NDPH variant. Criteria are proposed for diagnosis similar to ICHD-3 for NDPH with the following change: “pain becoming daily within 24 hours of onset with a duration of 4 to 24 hours without acute or preventive medication or other treatment.”
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Affiliation(s)
- Randolph W Evans
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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40
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Papetti L, Sforza G, Tarantino S, Moavero R, Ruscitto C, Ursitti F, Ferilli MAN, Vigevano F, Valeriani M. Features and Management of New Daily Persistent Headache in Developmental-Age Patients. Diagnostics (Basel) 2021; 11:diagnostics11030385. [PMID: 33668316 PMCID: PMC7996357 DOI: 10.3390/diagnostics11030385] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction. Our aim was to investigate the clinical features of primary new daily persistent headache (NDPH) in a cohort of paediatric patients. Methods. We reviewed the data of patients with persistent daily headache, attending the Headache Centre of Bambino Gesù Children from the January 2009. The ICHD-III criteria were used for diagnosis. Statistical analysis was conducted to study possible correlations between NDPH and population features (age and sex), NDPH and headache qualitative features, and NDPH and response to pharmacological therapies. Results. We included 46 subjects with NDPH. The features of pain more closely resembled those of migraine than to those of tension-type headache (62 vs. 38%). The NDPH patients showed nausea and vomiting less frequently than migraine ones (28.6 vs. 48.2%, p < 0.01). A total of 75% of NDPH patients experienced an onset of the symptoms in the winter months (November to February) (p < 0.01). NDPH was less common in very young children under 10 years of age. Almost 58% of NDPH patients received pharmacological therapy and the most used drug was amitriptyline. A reduction of attacks by at least 50% in a month was detected in 30.6% of patients. Conclusions. NDPH can be very disabling and correlates with seasonal factors. Although long term pharmacological therapy is recommended, considering the long duration that this headache can have, there are no data supporting the treatment choice.
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Affiliation(s)
- Laura Papetti
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
| | - Giorgia Sforza
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
| | - Samuela Tarantino
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
| | - Romina Moavero
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
- Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, 00133 Rome, Italy;
| | - Claudia Ruscitto
- Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, 00133 Rome, Italy;
| | - Fabiana Ursitti
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
| | - Michela Ada Noris Ferilli
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
| | - Federico Vigevano
- Department of Neuroscience, Neurology Unit, Bambino Gesù Children Hospital, 00165 Rome, Italy;
| | - Massimiliano Valeriani
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, 00165 Rome, Italy; (L.P.); (G.S.); (S.T.); (R.M.); (F.U.); (M.A.N.F.)
- Center for Sensory-Motor Interaction, Aalborg University, 9220 Aalborg, Denmark
- Correspondence: ; Tel.: +39-066-859-2289
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Pohl H, Gantenbein AR. [COVID-19 and Headaches]. PRAXIS 2021; 110:201-206. [PMID: 33726510 DOI: 10.1024/1661-8157/a003661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
COVID-19 and Headaches Abstract. Headaches are a common symptom of COVID-19 infections. Patients generally describe them as bilateral, predominantly frontal, squeezing and of moderate or severe intensity. Searching for "Red Flags" often allows distinction from primary headaches - usually fever, cough, and elevated inflammatory markers accompany COVID-19-associated headaches. Prospective studies did not confirm caveats against the use of ibuprofen as symptomatic treatment. While carrying facial masks often caused headaches, probably by compressing sensory nerves, many patients' migraine frequencies dropped during lockdown. Treatment of patients with primary headaches was complicated by quarantine and many centres offered online consultations.
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Affiliation(s)
- Heiko Pohl
- Klinik für Neurologie, Universitätsspital Zürich
| | - Andreas R Gantenbein
- Klinik für Neurologie, Universitätsspital Zürich
- Neurologie & Neurorehabilitation, RehaClinic Bad Zurzach
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Liu JWTW, de Luca RD, Mello Neto HO, Barcellos I. Post-COVID-19 Syndrome? New daily persistent headache in the aftermath of COVID-19. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:753-754. [PMID: 33331469 DOI: 10.1590/0004-282x20200187] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/18/2022]
Affiliation(s)
| | | | | | - Igor Barcellos
- Hospital Universitário Cajuru, Department of Neurology, Curitiba PR, Brazil
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Abstract
PURPOSE OF REVIEW Headaches are not only responsible for restrictions in everyday life in adults. In children and adolescents, regular headaches lead also to reduced life quality and limitations in the social sphere, in school education, and in professional careers. Here, we provide an overview on the frequency of headache in children and adolescents with the aim of increasing awareness about this particular health issue. RECENT FINDINGS Overall, headache prevalence in children and adolescents has been increasing in recent years. From various regions worldwide, data describing headache, its forms, and consequences are growing. In addition, factors frequently correlated with headache are repeatedly investigated and named: besides genetic factors, psychosocial and behavioral factors are linked to the prevalence of headache. Increasing evidence indicates that headache is underestimated as a common disorder in children and adolescents. Accordingly, too little emphasis is placed by society on its prevention and treatment. Thus, the extent of the social and health economic burden of frequent headaches in children and adolescents needs to be better illustrated, worldwide. Furthermore, the data collected in this review should support the efforts to improve outpatient therapy paths for young headache patients. Factors correlating with headache in pupils can draw our attention to unmet needs of these patients and allow physicians to derive important therapy contents from this data.
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Affiliation(s)
- Vera Nieswand
- Headache Clinic, Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstr 74, 01307, Dresden, Germany
| | - Matthias Richter
- Department of Pediatrics, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Gudrun Gossrau
- Headache Clinic, Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstr 74, 01307, Dresden, Germany.
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Dragan S, Șerban MC, Damian G, Buleu F, Valcovici M, Christodorescu R. Dietary Patterns and Interventions to Alleviate Chronic Pain. Nutrients 2020; 12:nu12092510. [PMID: 32825189 PMCID: PMC7551034 DOI: 10.3390/nu12092510] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 12/14/2022] Open
Abstract
Pain is one of the main problems for modern society and medicine, being the most common symptom described by almost all patients. When pain becomes chronic, the life of the patients is dramatically affected, being associated with significant emotional distress and/or functional disability. A complex biopsychosocial evaluation is necessary to better understand chronic pain, where good results can be obtained through interconnected biological, psychological, and social factors. The aim of this study was to find the most relevant articles existent in the PubMed database, one of the most comprehensive databases for medical literature, comprising dietary patterns to alleviate chronic pain. Through a combined search using the keywords “chronic pain” and “diet” limited to the last 10 years we obtained 272 results containing the types of diets used for chronic pain published in the PubMed database. Besides classical and alternative methods of treatment described in literature, it was observed that different diets are also a valid solution, due to many components with antioxidant and anti-inflammatory qualities capable to influence chronic pain and to improve the quality of life. Thirty-eight clinical studies and randomized controlled trials are analyzed, in an attempt to characterize present-day dietary patterns and interventions to alleviate chronic pain.
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Affiliation(s)
- Simona Dragan
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timișoara, Romania; (S.D.); (F.B.); (M.V.); (R.C.)
- Institute of Cardiovascular Diseases Timișoara, 13 Gheorghe Adam Street, 300310 Timișoara, Romania
| | - Maria-Corina Șerban
- Department of Functional Sciences, “Victor Babeș” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timișoara, Romania
- Correspondence: (M.-C.Ș.); (G.D.); Tel.: +40-256-493-085 (M.-C.Ș.); +40-727-702-052 (G.D.)
| | - Georgiana Damian
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timișoara, Romania; (S.D.); (F.B.); (M.V.); (R.C.)
- Correspondence: (M.-C.Ș.); (G.D.); Tel.: +40-256-493-085 (M.-C.Ș.); +40-727-702-052 (G.D.)
| | - Florina Buleu
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timișoara, Romania; (S.D.); (F.B.); (M.V.); (R.C.)
| | - Mihaela Valcovici
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timișoara, Romania; (S.D.); (F.B.); (M.V.); (R.C.)
- Institute of Cardiovascular Diseases Timișoara, 13 Gheorghe Adam Street, 300310 Timișoara, Romania
| | - Ruxandra Christodorescu
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timișoara, Romania; (S.D.); (F.B.); (M.V.); (R.C.)
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de Abreu LV, Oliveira CB, Bordini CA, Valença MM. New Daily Persistent Headache Following Dengue Fever: Report of Three Cases and an Epidemiological Study. Headache 2019; 60:265-268. [PMID: 31883109 DOI: 10.1111/head.13718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Dengue fever is currently a significant public health problem as an emerging pandemic-prone viral disease in many parts of the world. Up to 100 million individuals, distributed in over 100 countries, are estimated to be infected annually, putting nearly half of the world's population at risk. The headache associated with dengue fever is considered to be very intense, bilateral, throbbing, frontal, and retro-orbital. New daily persistent headache (NDPH) is a relatively rare headache entity. It has already been reported that systemic infectious disease may precede the onset of NDPH. We report the data of an epidemiologic study analyzing the cases of NDPH among 450 subjects who had dengue fever. METHOD The study was performed in a medium-size town in southeastern Brazil (Franca, population 370,000). During the year 2015, 600 cases of dengue fever were reported to the Franca Health Authority. All these patients were contacted by telephone, and 450 of the patients were located and interviewed. RESULTS Of these 450 interviews, three possible cases of NDPH were identified. CONCLUSION The observed prevalence of NDPH attributed to dengue fever was 1:150 cases of dengue fever (0.67%).
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