Assessment of the Balance and Dizziness Objectification in Patients with Vestibular Bilous Headache

Study Objective: To study the balance in patients with vestibular bilious headache (BH) and possible use of a special comprehensive stabilometrical program for dizziness objectification in them. Study Design: open comparative study. Materials and Methods. The study included 188 patients. Group 1 were 94 patients with confirmed BH (according to the International Headache Classification). Group 2 were 94 patients with common migraine. The stabilometrical control group included 94 healthy subjects. The balance and dizziness objectification were assessed using a special comprehensive method comprising a set of stabilometrical tests. Study Results. The most marked changes in stabilometrical parameters were recorded in patients with BH. Primary frequency spectra of these patients were in a range of 0.3 Hz and above 2 Hz, showing the dysfunction of the postural system and vestibular component in particular. The rate of pressure centre deviation and statokinesigram area were increased in the patients from group 2 vs controls; however, statistically significant differences were noted only in opticokinetic test, sensory and vestibular, and closed-eye tandem results. Comparison of the two clinical groups demonstrates significant differences in basic stabilometrical parameters of all challenge tests. Visual control exclusion as well as substandard visual stimulation had significant impact on changes in the analysed parameters. Conclusion. The use of special stabilometrical tests (opticokinetic stimulation, sensory and vestibular and tandem tests) described in this article allows assessing the balance, quantifying vestibular dysfunction in patients with BH, and objectifying dizziness. Keywords: dizziness, balance, vestibular migraine, computer-aided stabilometry.

EFFICASY OF THE USE OF NOOFEN® IN THE TREATMENT OF TENSION TYPE HEADACHE

We conducted a study including patients with tension type headache (TTH) (n = 60) at the age of 37.2 ± 10.2. The criteria for the International Headache Classification, third edition (beta version) were used. The following outcome measures were compared: EEG, visual analog scale (VAS), hospital anxiety and depression scale (HADS), Beck Depression Inventory (BDI), pulse variation measurement, Wein Scale. 60 patients presenting with TTH were randomly assigned to phenibut (500 mg/day) or selective serotonin reuptake inhibitors (SSRI) for 4 weeks. The findings indicate the potential benefit of phenibut as effective and safe symptomatic therapy in diverse forms of tension type headache.

Explicit diagnostic criteria for transient ischemic attacks to differentiate it from migraine with aura

Background The diagnosis of transient ischemic attacks is fraught with problems. The inter-observer agreement has repeatedly been shown to be low even in a neurological setting, and the specificity of the diagnosis is modest to low, reflected in a poor separation of transient ischemic attacks and mimics, particularly migraine with aura with its varied symptomatology. In other disease areas, explicit diagnostic criteria have improved sensitivity and specificity of diagnoses. We therefore present novel explicit diagnostic criteria for transient ischemic attacks tested for sensitivity and for specificity against migraine with aura. Methods The proposed criteria were developed using the format of the international headache classification. We drew upon the existing literature about clinical characteristics and diagnosis of migraine with aura and transient ischemic attacks. We tested the criteria for sensitivity in a prospectively-collected material of 120 patients with transient ischemic attacks diagnosed before we developed the criteria using extensive semi-structured interview forms in the acute phase after admission. Eligible patients had focal brain or retinal ischemia with resolution of symptoms within 24 hours without presence of new infarction on magnetic resonance imaging with diffusion weighted imaging (n = 112) or computed tomography (n = 8). These criteria were also tested for specificity against a Danish (n = 1390) and a Russian (n = 152) material of patients with migraine with aura diagnosed according to the International Classification of Headache Disorders edition 3 (beta). Results The sensitivity of the proposed criteria was 99% in patients with transient ischemic attacks. The specificity was 95% in the Danish material of patients with migraine with aura and 96% in the Russian material. Conclusions Proposed explicit diagnostic criteria for transient ischemic attacks showed both high specificity and sensitivity. They are likely to improve the emergency room diagnosis of transient ischemic attacks. Further testing in unselected materials referred to transient ischemic attacks clinics was beyond the scope of the present study but is recommended for future study.

MIGRAINE: A POSSIBLE CAUSE FOR COGNITIVE DECLINE

Objectives:Migraine is the second most common type of headache and seventh most disabling disease worldwide. In general, obesity is often related to headache disorders in several clinical and epidemiologic studies. Obese migraine patients may have an increased attack frequency due to increase in inflammatory response. Cognitive decline is the major pitfall of migraine disorder and there exists a conflicting result between cognition and migraine and the effect of Body Mass Index (BMI) on migraine. So this study is done to find out the relationship between cognition and migraine and its association with BMI.Methods:The study protocol was approved by the ethical committee of SRM Medical College Hospital & Research Centre. The study group consisted of 30 migraine patients and 30 healthy controls aged between 18-40 years of age. Informed consent was obtained from all the participants. Diagnosis of migraine was made using the criteria of 2nd edition of International Headache Classification (IHC). Patients affected by Diabetes mellitus, Hypertension, allergy, inflammation, infection or immune disorders were excluded. Height and weight of the subjects were taken to calculate the BMI. Cognitive tests such as stroop interference trial & trial making tests (A&B) were done to evaluate working memory, mental flexibility and attention.Results:Compared to controls, cases took more time for performing stroop colour card test (106.40 ± 15.87 seconds vs. 132.17±7.027seconds, p<0.001) and trial making pattern B (54.77± 8.169 seconds vs. 56.23 ± 23.457seconds, p=0.004). Among the migraine subjects, obese individuals had an increased frequency of migraine attack per month (Correlation coefficient r=0.797)Conclusion:Cognitive decline in migraine is one of the underestimated problems in migraine. Identifying such problems early can prevent major consequences in day to day activities of migraine patients. Since there is an increased frequency of migraine with increase in BMI, obese migraine subjects can be recommended to do regular exercises.Key words: Migraine, Cognition, Stroop test, Obesity.

Prospective three-year follow up of a cohort study of 240 patients with chronic facial pain

Background:Patients often present with facial pain ascribed to sinusitis, despite normal nasal endoscopy and sinus computed tomography. Facial pain is increasingly recognised to be of neurological origin.Method:A cohort of 240 patients with chronic facial pain was followed up for 36 months at an otolaryngological practice in Malta. The types of facial pain were classified according to International Headache Classification criteria. The body mass index, occupation and educational level of patients were compared with the general population.Results:Tension-type mid-facial pain and facial migraine without aura were the most common types of chronic facial pain. The sites of pain, symptoms, treatment and outcomes for these principal pain types are discussed. Patients with mid-facial pain were treated with low-dose amitriptyline for eight weeks. After three years, nearly half of the patients were symptom free, and in a third the pain changed from being chronic to being episodic. The treatment of patients with facial migraine was more varied but the length of time until recurrence of pain was similar.Conclusion:The most effective long-term treatments for tension-type mid-facial pain and facial migraine were low-dose amitriptyline and low-dose amitriptyline and triptans, respectively.

An Update on the Less-known Group of Other Primary Headaches – A Review

Headache represents one of the most common symptoms in the emergency department. A systematic approach to headache classification is essential for diagnosis and efficient therapeutic management. New International Headache Classification (ICHD-3 beta) criteria provide a dynamic clinically useful instrument, establishing both uniform terminology and consistent operational diagnostic criteria for a broad range of headache disorders. This article reviews and highlights developments in our knowledge of “Other Primary Headaches”, including primary stabbing headache, primary cough headache, primary exercise headache, primary headache associated with sexual activity, hypnic headache, primary thunderclap headache, cold-stimulus headache, nummular headache, external-pressure headache and new daily persistent headache. Clinicians should be aware that these headaches may be symptomatic to structural lesions and therefore require careful neuroimaging and laboratory evaluation.

Change in intraindividual ICHD-II headache diagnosis over time: A follow-up of the DMKG headache study

Background Change in headache diagnoses over time within the same individual is not well studied in the adult population. In this study, we prospectively examined the individual variation of migraine and tension-type headache (TTH) diagnoses over time. Methods As part of the epidemiological Deutsche Migräne und Kopfschmerzgesellschaft (DMKG) headache study, 1312 participants were personally interviewed and 1122 responded to a second mailed questionnaire 2.2 years later. Headaches were assigned to migraine or TTH at two different points in time using the International Headache Classification, ICHD-II. We used broad (definite and probable subtypes) and strict (only definite type) definitions of migraine and TTH. Results Using the broad definition increased the reproducibility of migraine diagnosis from 48.0% to 62.0% and of TTH from 59.0% to 65.0%. A constant TTH diagnosis was related to a higher social status (OR 2.81; 95% CI 1.43–5.53) a higher level of education (OR 1.96; 95% CI 1.00–3.85) and physical inactivity (OR 2.28; 95% CI 1.16–4.49). A constant diagnosis of definite migraine was associated with severe headache (OR 2.64; 95% CI 0.97–7.21) and frequent use of headache medication (OR 4.73; 95% CI 0.95–23.60). The result that coexisting TTH decreased the likelihood of a constant migraine (OR 0.29; 95% CI 0.10–0.85) is assumed to indicate response variability. Conclusions In epidemiological studies, definite and probable subtypes should be included in the diagnosis to increase the diagnostic accuracy.

Personal Disorders in Local Wars Participants with and Without Headache

It's known that personal disorders is very often pathology in local wars participants.The aim of the current research was to study how the chronic pain syndrome (headache) influence to personality.Materials:162 patients (only men) had been investigated. They are divided into two groups according to age and local war in which they had got taking part: first group - the participants of Afghanistan's war (84 men, middle age 46,3±1,38), and second one - the participants of local war in Chechnya (78 men, middle age 32,7±1,54).We used Leonhard's questionnaire to reveal the character's accentuation and second edition of International headache classification to determine headache type.Results:It seems that 113 patients suffer from cephalgia. Another 49 was a control. During the investigation of headache syndrome structure we have shown that most often patients suffer from posttraumatic headache (PH) - 61 men, and tension-type of headache (TTH) - 33 men.The number of men having got 18 and more in one or several scales of Leonhard's questionnaire is reliable more in the first group both for PH (85,7% and 69,2%) and TTH (85,7% and 68,9%). There were no differences between headache subgroups. But in patients from control group (without headache) the expression of personality changes did not increase during the age (69,6% in first group, 73,1% in second). So chronic pain may be a risk factor for decompensation of personality changes.

Hemodialysis-related headaches

Background/Aim. Hemodialysis (HD) is a therapeutic procedure used to partially correct homeostatic disorders and prevent complications of uremia to appear in the terminal stage of renal insufficiency. The aim of this study was to evaluate and analyze the incidence and features of headaches in patients undergoing hemodialysis. Methods. A total of 143 patients, 50 women and 93 men, undergoing hemodialysis, were questioned about their problems with headache using a questionnaire designed according to the diagnostic criteria of the International Headache Classification of Headache Disorders from 2004. The patients were separated into two groups: the patients without headache and the patients with repeated headaches. Afterwards, the patients with headaches were further divided into subgroups: the patients who had the headaches before the beginning of HD and patients who experienced repeated headaches with the beginning of HD headache (HDH). In the group of patients with headaches we analyzed characteristics of headache according to which diagnoses of headaches were made, as well as the effects of HD on headaches. We also analyzed features of HDH. The patients with headache were compared to the patients without headache regarding sex, age, duration of HD, causes of end-stage renal disease, arterial diastolic and systolic blood pressure and serum concentration of hemoglobin, urea nitrogen, creatinine, sodium and potassium. The results were statistically compared. Results. In the group of 143 patients examined, 27 (18.9%) patients had headaches. There were no statistically significant differences between the group of patients with headaches and those without headache regarding to sex, age, duration of HD, causes of end-stage renal disease, serum concentration of hemoglobin, urea nitrogen, creatinine, sodium and potassium. The patients with headaches showed significantly higher mean values of systolic blood pressure during HD in comparison to the patients without headaches (p = 0.029). There was no statistically significant difference between the two groups regarding the mean values of diastolic blood pressure. Nineteen (13.3%) patients had had headache before starting HD. HD did not have any effect on the characteristics of headaches in more than a half of these patients. In 8 (5.6%) patients we diagnosed HDH using the diagnostic criteria of the International Headache Classification of Headache Disorders from 2004. HDH showed similar characteristics in all the patients: it appeared mostly in men, during the 4th hour of HD, lasted less than four hours, it was localized bilaterally in the frontal parts of the head, strong in intensity, throbbing and without the associated symptoms. Conclusion. The results of our study clearly showed that HDH was a particular entity of headache, not only because of its connection with HD, but because it had similar characteristics in all the patients in which it had appeared. Finding out the pathophysiological mechanisms of their occurrence would significantly improve the quality of life style of patients on hemodialysis. .