Caffeine for Headaches: Helpful or Harmful? A Brief Review of the Literature

Consumption of caffeine in the diet, both daily and occasional, has a significant biological effect on the nervous system. Caffeine, through various and not yet fully investigated mechanisms, affects headaches. This is especially noticeable in migraine. In other headaches such as hypnic headache, post-dural puncture headache and spontaneous intracranial hypotension, caffeine is an important therapeutic agent. In turn, abrupt discontinuation of chronically used caffeine can cause caffeine-withdrawal headache. Caffeine can both relieve and trigger headaches.

Variability in melatonin concentration in blood serum of patients with episodic migraine: a pilot study

AIM OF STUDY

This study was aimed at assessing the possible effect of melatonin concentration on migraine. The serum concentration profile of melatonin in patients with diagnosed episodic migraine in the interictal period was compared to the profile in patients without migraine. Then, a correlation between the frequency and duration of migraine attacks, and the possible relationship between these parameters and melatonin levels in individual patients, was established.

CLINICAL RATIONALE FOR STUDY

Melatonin secretion is related to migraine pathophysiology in many different ways.

MATERIALS AND METHODS

The study was conducted in a group of 58 subjects (48 women and 10 men). The study group comprised 29 patients (24 women and five men) diagnosed with migraine according to the International Classification of Headache Disorders (ICHD-3 beta), within the framework of the Outpatient Clinic at Bielanski Hospital in Warsaw and the Clinical Department of Neurology of the 2nd Faculty of Medicine (now known as the Faculty of Medical Sciences) at the Medical University of Warsaw, Poland. The control group consisted of 29 subjects (24 women and five men) with no headache. Blood samples for the determination of melatonin were collected at midnight, 2am, 3am, 4am and 6am. Melatonin level in a frozen serum of venous blood was determined by a radio-immuno-enzymatic method at the Department of Histology and Embryology of the Faculty of Veterinary Medicine at the University of Warmia and Mazury in Olsztyn, Poland.

RESULTS

No statistically significant differences between the levels of melatonin and the averaged advances of melatonin profiles were observed in the examined and the control group. There were demonstrated medium negative correlations between the maximum value of melatonin and the duration of migraine (R = -0.4, p = 0.03). There were also observed statistically significant differences (p = 0.01) between the averaged advances of melatonin profiles, depending on the duration of migraine.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Our study showed no abnormalities of melatonin secretion in patients with migraine during the interictal period. The results of studies available in the literature depend on the nature of the headache (episodic or chronic) and the time of measuring the concentration of melatonin (during a headache attack or in an interictal period).

Low-symptomatic skeletal muscle disease in patients with a cardiac disease - Diagnostic approach in skeletal muscle laminopathies

Mild skeletal muscle symptoms might be accompanied with severe cardiac disease, sometimes indicating a serious inherited disorder. Very often it is a cardiologist who refers a patient with cardiomyopathy and/or cardiac arrhythmia and discrete muscle disease for neurological consultation, which helps to establish a proper diagnosis. Here we present three families in which a diagnosis of skeletal muscle laminopathy was made after careful examination of the members, who presented with cardiac arrhythmia and/or heart failure and a mild skeletal muscle disease, which together with positive family history allowed to direct the molecular diagnostics and then provide appropriate treatment and counseling.

A severe recessive and a mild dominant form of Charcot-Marie-Tooth disease associated with a newly identified Glu222Lys GDAP1 gene mutation

Charcot-Marie-Tooth (CMT) disease caused by mutations in the GDAP1 gene has been shown to be inherited via traits that may be either autosomal recessive (in the majority of cases) [CMT4A] or autosomal dominant [CMT2K]. CMT4A disease is characterized by an early onset, and a severe clinical course often leading to a loss of ambulation, whereas CMT2K is characterized by a mild clinical course of benign axonal neuropathy beginning even in the 6th decade of life. Clinical data from a GDAP1 mutated patient suggests that the presence of a particular mutation is associated with a certain trait of inheritance. The association of a particular GDAP1 gene mutation and a dominant or recessive trait of inheritance is of special importance for genetic counseling and the prenatal diagnostics as regards severe forms of CMT. In the present study we report on two CMT families in which a newly identified Glu222Lys mutation within the GDAP1 gene segregates both in autosomal dominant and recessive traits. Our study shows that at least some GDAP1 gene mutations may segregate with the CMT phenotype as both dominant and recessive traits. Thus, genetic counseling for CMT4A/CMT2K families requires more extensive data on GDAP1 phenotype-genotype correlations.

A severe recessive and a mild dominant form of Charcot-Marie-Tooth disease associated with a newly identified Glu222Lys GDAP1 gene mutation

Charcot-Marie-Tooth (CMT) disease caused by mutations in the GDAP1 gene has been shown to be inherited via traits that may be either autosomal recessive (in the majority of cases) [CMT4A] or autosomal dominant [CMT2K]. CMT4A disease is characterized by an early onset, and a severe clinical course often leading to a loss of ambulation, whereas CMT2K is characterized by a mild clinical course of benign axonal neuropathy beginning even in the 6th decade of life. Clinical data from a GDAP1 mutated patient suggests that the presence of a particular mutation is associated with a certain trait of inheritance. The association of a particular GDAP1 gene mutation and a dominant or recessive trait of inheritance is of special importance for genetic counseling and the prenatal diagnostics as regards severe forms of CMT. In the present study we report on two CMT families in which a newly identified Glu222Lys mutation within the GDAP1 gene segregates both in autosomal dominant and recessive traits. Our study shows that at least some GDAP1 gene mutations may segregate with the CMT phenotype as both dominant and recessive traits. Thus, genetic counseling for CMT4A/CMT2K families requires more extensive data on GDAP1 phenotype-genotype correlations.

[Electrophysiological evaluation of peripheral nerves in ischemic lower limbs]

The study concerned electrophysiological parameters during stimulation of peroneal, tibial, sural and femoral nerves of patients with ischemia of lower limbs. The disease was clinically verified and confirmed on the basis of an ankle-brachial index (ABI). Peripheral nerves injuries caused by other reasons have been excluded from the research. For statistical evaluation of the material, groups of 86 chronic ischemic limbs (ABI < 0.91) and 57 healthy ones (ABI > 0.99) were created. All observation allowed to recognize an axonal-demyelization neuropathy, with strong axonal element. Changes concerned mainly long nerves. Coexistence of spinal roots damage was often (75.4%) noticeable. The correlation between degree of ischemia (ABI) and studied parameters has not been noticed. We described 5 cases of acute ischemia. There was no significant improvement after surgical or conservative therapy.

[The role of sodium serum level disturbances in the development of central pontine myelinolysis]

Central pontine myelinolysis now is believed to be a polyetiological syndrome. Our case was diagnosed clinically due to typical neurological symptoms occurred in the course of the treatment hyponatraemia and hypokaliaemia. Forty six years old woman an alcohol abuser, with liver dysfunction was admitted to neurological department in the first grand mall attack. She was tetraplegic, with signs of alcoholic polyneuropathy simultaneously hyponatraemia and hypokaliaemia were observed. Two weeks after normalization of electrolytic alterations, symptoms of brain stem lesion appeared. Based on MRI and clinical symptoms the diagnosis of central pontine myelinolysis was suggested and proved on autopsy. Electrolytic disturbances and treatment are discussed.

[Cigarette smoking and alcohol abuse effects on stroke development]

Cigarette smoking, alcohol abuse and stroke--the material consisted of 272 patients (169 men and 103) women aged between 25-65 years. There were 221 patients with ischemic stroke and 51 patients with haemorrhagic stroke. The control group consisted of 400 healthy subject of the same age and sex. In the stroke group excessive consumption of alcohol was reported by 61 patients (5 women and 56 men). Excessive smoking was reported by 130 patients (41 women and 89 men). It was found in both types of stroke alcohol was not an independent risk factor. In addition, the study revealed that alcohol and cigarette smoking did not increase the risk of developing stroke in patients with diabetes and hypertension. Excessive cigarette smoking was found however, to be an independent risk factor in haemorrhagic stroke.