Frequency of Headaches in Macromastia Patients and Relief After Reduction Mammoplasty

Background Several studies have reported that neck, back, and shoulder pain can be reduced after macromastia. However, only 1 study has specifically investigated the relation between macromastia and headaches. Objectives This study aimed to determine the frequency of headaches in patients with macromastia by examining a sample from our clinic and to determine whether the patients experienced headache relief following breast reduction surgery. Methods One hundred patients, out of 456 patients who met the criteria, were contacted by telephone and administered a questionnaire. Statistical analysis was performed with SPSS version 17.0. Normal distribution of the variables was examined by histograms and Kolmogorov-Smirnov tests. Pearson’s chi-square and Fisher’s exact tests were used to compare groups. The Mann-Whitney U test was used to evaluate nonparametric variables between the patients who has 1500 grams or less breast tissue removed and the patients more than 1500 grams breast tissue removed. Results The incidence of headaches in patients with macromastia was found to be 29%. Among the patients with headaches, 65.52% reported relief after surgery. The relief rate for headaches was found to be associated with the amount of tissue removed. Conclusions The incidence of headaches increased in patients with macromastia compared with the general population, and patients reported headache relief after surgery. In addition, as the amount of tissue removal increased, the relief rate for headaches after surgery also increased. Although additional studies are essential, preoperative headaches should be evaluated in breast reduction patients, and the removal of larger amounts of breast tissue should be considered among patients who report headaches. Level of Evidence: 4

THE EFFECTIVENESS OF MYOFASCIAL RELEASE IN THE CERVICAL REGION FOR TENSION HEADACHE RELIEF

Myofascial release is a manual thrust applied to the body face to treat the facial system. Myofascial release restores the flexibility and elasticity of the fascia, thus having a broad ability to alter the body's range of motion and dissolve restrictions in the fascial tissues. Sedentary lifestyle and positions that cause pain can gradually cause muscle and fascial restrictions and shortening. This study aims to identify the effectiveness of myofascial release in the cervical region for tension headache relief. This study is characterized as a bibliographical research of qualitative descriptive character, where the researcher is the one who describes the research object, assuming the role of observer and explorer, directly collecting the data in the place where the study phenomena occurred or appeared. It is concluded that through the use of this technique, it is possible to deactivate trigger points, promote a correct alignment of the body structure, minimize movement restriction and pain without compromising the myofascial structures.

The Relevance View: Defended and Extended

The Relevance View, exemplified by Alex Voorhoeve's Aggregate Relevant Claims, has considerable appeal. It accommodates our reluctance to aggregate weak claims in canonical cases like Life for Headaches (where one person's claim to life-saving treatment competes with millions of claims for headache relief), while permitting aggregation of claims in a range of other cases. But it has been the target of significant criticism. In an important recent paper, Patrick Tomlin argues that the view suffers from failures of internal logic, violating plausible consistency constraints and generating incoherent combinations of verdicts on cases. And in cases resembling real-world healthcare allocation problems, Tomlin argues that the view offers no guidance at all. In response, I argue that the internal logic of the Relevance View is sound, and the view's core principles, suitably clarified, support a significant extension of the view beyond the simple cases to which it is typically applied.

Headache and rhinosinusitis: A review

Purpose of review To explain our current understanding of headache attributed to rhinosinusitis, an often inappropriately diagnosed secondary headache. Recent findings Recent studies have shown that headache attributed to rhinosinusitis is often over-diagnosed in patients who actually have primary headache disorders, most commonly migraine. Failure to recognize and treat rhinosinusitis, however, can have devastating consequences. Abnormalities of the sinuses may also be treatable by surgical means, which may provide headache relief in appropriately selected patients. Summary It is important for the practicing physician to understand how rhinosinusitis fits into the differential diagnosis of headache, both to avoid overdiagnosis in patients with primary headache, and to avoid underdiagnosis in patients with serious sinus disease.

Pain freedom after 2 hours should be the primary outcome in controlled trials treating migraine attacks

Background Pain freedom after 2 hours is the recommended primary endpoint by the International Headache Society in randomized trials investigating drug treatment of acute migraine attacks. In order to demonstrate an early effect of a drug, some drug companies, however, have promoted headache relief (improvement from severe or moderate pain to mild or no pain) at earlier time points than 2 hours as outcome parameter. Methods and results We analyzed the relationship between pain freedom and headache relief in acute migraine trials and observed that persistent mild headache constituted 90% of headache relief after 0.5 hour and 40% of headache relief after 2 hours. Conclusion Headache relief at 2 hours should in our view only be used as an outcome measure for comparison with historic data. Prior to 2 hours, headache relief varies with time from intake and the therapeutic gain is very small. Therefore, pain freedom should be used at these early time points.

Methodical history taking may help in timely diagnosis of spontaneous intracranial hypotension

Orthostatic headache (OH) is a key symptom of spontaneous intracranial hypotension (SIH). However, there is no optimal history taking for OH. A 35-year-old man complained of headache that prevented him from performing routine physical activities, which was relieved on lying down. We initially considered migraine as the most likely diagnosis. However, detailed history taking revealed that his headache worsened on standing, and he was finally diagnosed with SIH. Headache relief on lying down is not a specific indicator of OH associated with SIH. Thus, with regard to headache history taking, we suggest it important to confirm headache aggravation on standing.