Form Of Headache Research Articles

Predisposition of 7–10-year-old children to accommodative spasm – findings from studies on the quality of binocular vision

Wstęp: Celem pracy była ocena jakości widzenia obuocznego oparta na pomiarach wybranych parametrów charakteryzujących funkcję układu wzrokowego wśród dzieci szkolnych oraz identyfikacja objawów związanych z akomodacją.Materiały i metody: Przeprowadzono badania okulistyczne u 300 dzieci (180 dziewczynek, 120 chłopców) w wieku 7–10 lat. Zaplanowane zostały dwie części: a) ankietowa – wywiad na temat dolegliwości towarzyszących skurczowi akomodacji i heteroforii; b) okulistyczna – ocena przedniego odcinka i dna oczu, pomiar ostrości wzroku do dali, badanie refrakcji przed cykloplegią i po cykloplegii, ruchomości i ustawienia oczu, pomiar zdysocjowanej forii horyzontalnej do bliży i do dali metodą Maddoxa. Otrzymane wyniki poddano analizie statystycznej za pomocą programu Statistica 10. Wartość p < 0,05 uznano za statystycznie znamienną.Wyniki: Stwierdzono następujące wady refrakcji: emmetropia (u 52 dzieci), nadwzroczność (9 dzieci), krótkowzroczność (239 dzieci). Skurcz akomodacji występował u 10 dzieci (3,5–8 Dsph). Heteroforia: u większości dzieci występowała egzoforia (do bliży – u 240 dzieci; do dali – u 112 dzieci). Egzoforia do bliży była w przedziale 5–12 Dpryzm. Wśród dzieci z dobrą ostrością wzroku wynoszącą 1,0 (218 dzieci) egzoforię stwierdzono u 180 (p = 0,29307). Brak odruchu zbieżności najczęściej obserwowano u 158 dzieci z egzoforią do bliży (p = 0,14929).Wnioski: Skargi na bóle głowy i oczu najczęściej zgłaszały dzieci ze zdysocjowaną poziomą forią odbiegającą od przyjętej normy. Trudności ze skupieniem w trakcie czytania z bliska oraz objawy o charakterze pogorszenia widzenia najczęściej zgłaszały dzieci z nieprawidłową wartością zdysocjowanej forii, która prawdopodobnie predysponowała do skurczu akomodacji.

A Short Review of the Non-invasive Transcutaneous Pericranial Electrical Stimulation Techniques and their Application in Headache.

In this short review, the most common non-invasive neuromodulatory techniques will be described, along with their advantages and disadvantages and their application in headache. Available preventive treatments can be unhelpful or may have unpleasant side effects; moreover, the rate of response to preventive drugs does not exceed 50%, lower in chronic migraine; alternative options would be welcome. Though the concept of neuromodulation was originally developed with invasive methods, newer non-invasive techniques are appearing. The novel neuromodulatory techniques have been developed with encouraging results: compared with traditional pharmacotherapy, advantages of non-invasive neuromodulation include reduced incidence of adverse effects, improved adherence, and safety and ease of use. The results are encouraging for acute or preventive treatment of different kinds of headache. A variety of neuromodulatory approaches is expanding fastly and has opened new possibilities for treatment of patients suffering from many forms of headache, especially those who have failed traditional pharmacotherapy. The non-invasive treatments can be seen as supplementing traditional management in refractory patients. Current study results are encouraging but preliminary and larger and more rigorous trials are needed to clarify benefit and mode of action.

Breath holding index in episodic primary headaches

Background/Aim. Examination of cerebrovascular reactivity in patients with primary headaches is focused mainly on migraine, while the smaller number of studies deals with tensiontype and cluster headache, or comparison of cerebral haemodynamic in migraine and tension-type headache (TTH). In this study, we hypothesized that cerebrovascular reactivity differs among different types of episodic primary headaches. In order to prove that we aimed to compare the interictal cerebrovascular reactivity in patients with the episodic form of the three most common types of primary headaches using the breath holding test. Methods. Examination was performed in 243 patients, 100 migraineurs with aura (group I), 70 migraineurs without aura (group II), 38 patients with episodic tension-type headache (group III), 35 patients with episodic form of cluster headache (group IV) and 35 healthy controls (group V). The Doppler instrument was used for transcranial doppler (TCD) sonography and breath-holding test performance. Blood flow mean velocities (MV), pulsatility indices (PI) and breath-holding index (BHI) for middle cerebral artery among these groups were analyzed. Results. The mean velocities and pulsatility indices were not different in 4 groups of headache patients and controls. The BHI was found to be significantly greater in the migraineurs with aura (1.668 ? 0.269) compared with the patients with migraineurs without aura (1.411 ? 0.358, p = 0.005), tension type headache (1.401 ? 0.428, p = 0.035), cluster headache (1.203 ? 0.311, p < 0.01) and controls (1.195 ? 0.269, p < 0.01) showing an exaggerated reactivity to hypercapnia in patients with migraine with aura. Conclusion. In conclusion, our finding support the literature data that increased cerebrovascular reactivity is a feature of migraine with aura. Result of unchanged cerebrovascular reactivity in migraine without aura, cluster headache and tension-type headache is expected, still, it is possible that in future, using different technique, we will be able to put more light on vascular changes that are following different headache disorders.

UPPER CERVICAL RADICULOPATHY: THE HIDDEN PATHOLOGY OF THE SPINE.

Axial neck pain can frequently be a vexing clinical problem for practitioners. Cervical spine surgery is generally regarded as less successful for axial neck pain than arm complaints. Although only few case series exist in the literature, there is evidence to suggest that upper cervical radiculopathy could be an important, treatable source of axial neck pain. Unlike patients with axial neck pain, patients with radiculopathy usually present with unilateral pain, particularly in the trapezial, parascapular, mid clavicular, or even in the form of suboccipital headaches. Similar to other regions of the cervical spine, initial imaging often consists of plain radiographs of the cervical spine, with the use of magnetic resonance imaging (MRI) or computed tomography (CT) if further evaluation of the pathology is warranted. Selective injections and electromyography can be used in conjunction with the imaging studies to aid with proper diagnosis. The surgical management of upper cervical radiculopathy is reserved for patients who fail to improve with non-operative modalities. Anterior cervical discectomy and fusion (ACDF) remain the most commonly performed and most reliable procedure for the treatment of cervical radiculopathy. Wide decompression of disc material from uncinate to uncinate is performed with or without a foraminotomy on the symptomatic side to address anterior compressive pathology. Artificial disc replacement (ADR) has been recently introduced in hopes of maintaining motion at the pathologic levels. Young patients (<40 years old) with minimal facet joint arthrosis are best indicated for this surgery. Posterior cervical foraminotomy avoids many approach related complications associated with anterior surgery and is the preferred approach when anterior surgery is contraindicated. Very few studies with small sample sizes (likely due to underdiagnosis) make it difficult to perform a comparative analysis of the different types of procedures. Ultimately, an accurate diagnosis is likely the most important predictor of a positive surgical outcome.

The prevalence of the palmo-mental reflex in patients with cervicocranialgia

To study characteristics of the palmo-mental reflex (PMR) in patients with cervicalgia accompanied by the most common forms of headaches: migraine, tension-type headache (TTH) and cervicogenic headache (CGH). Prevalence of PMR was studied in a sample of 142 patients with neck pain (mean age 39.1±12.1 years; 103 women and 39 men) accompanied by migraine, TTH or CGH. The first group included 66 patients (51 women and 15 men; mean age 39.4±12.8 years) with neck pain accompanied predominantly by migraine. The second group included 76 patients (52 women and 24 men; mean age 38.9±11.7 years) with TTH and/or CGH. The palmo-mental reflex was observed in 86.4% patients of the 1-st group and 7.0% of the second group (χ2=91.41; p=0.000). The results suggest the presence of anatomical and pathophysiological premises for occurrence of this reflex in patients with neck pain accompanied by migraine.

Efficacy of transdermal rotigotine in chronic cluster headache: A case series

Cluster headache (CH) is one of the most severe forms of headache, but the number of effective treatments is still limited. Recently, we reported the case of a drug-resistant CH patient responsive to the rotigotine transdermal patch, which is used in the treatment of Parkinson’s disease. This report formed the basis for a case series where other drug-resistant CH patients were treated with rotigotine. Here are the results of this study. Twenty-two CH patients underwent the treatment. Eight were episodic cluster headache (ECH) patients and 14 were chronic cluster headache (CCH) patients. Of the eight ECH patients, four reported that their CH had been stopped by the treatment. Of the 14 CCH patients, 11 were considered responders to the treatment (5 experienced a full resolution of headache, and 6 had a headache reduction of at least 50% in terms of mean monthly number of attacks). Our case series confirms the previous observation that rotigotine could be helpful in the treatment of CH. It may even influence the monoaminergic system that has a key role in the pathogenesis of CH.

A New Subtype of Chronic Daily Headache Presenting in Older Women

To describe a new subtype of chronic daily headache in women of a specific age group. Case series. Eight patients were included in the presented case series. The average age of onset of this distinct headache condition is 57 years. All patients were either perimenopausal or in menopause when the headaches started. The syndrome is marked by bilateral head pain that starts daily from onset and is typically at its most severe intensity the first thing in the morning before arising or when in the supine position. Immediate worsening in Trendelenburg appears to be an almost diagnostic test for the syndrome and occurred in all patients. The majority of the patients had a history of episodic migraine, but the migraines were either very well controlled or had ceased by the time the new headache arose. The bulk of the patients (6/8) were either overweight or obese, although two patients were of normal body mass index (BMI). Neuroimaging showed no abnormalities. All patients responded to cerebrospinal fluid (CSF) pressure-/volume-lowering medications (acetazolamide or spironolactone), but only one patient was able to completely taper off treatment without headache recurrence. This newly defined subtype of chronic daily headache appears to be caused by a state of elevated CSF pressure. It is hypothesized that a combination of an elevated BMI and the presence of cerebral venous insufficiency leads to this form of daily headache.

Cholinergic mechanisms of headaches

Headache is one of the widespread pain syndromes with polyneurochemical mechanisms. Here, we review the involvement of the cholinergic neurotransmitter system in the pathophysiology of various forms of headaches. Data on the sources of cholinergic and parasympathetic innervations of intracranial structures and distribution of N- and M-cholinoreceptors of various subtypes within the trigeminovascular system and their roles in the acetylcholine (ACh) effects on brain circulation and processing of nociception in headache are reviewed. We present data on the algogenic and anti-nociceptive effects of ACh in the peripheral and central parts of the trigeminal nerve system and its presumably analgesic effects at the supraspinal level of the CNS. We discuss the ACh-dependent mechanisms of the anticephalalgia action of pharmacological and nonpharmacological approaches that are used for the headache treatment and the future perspectives of the use of cholinergic drugs.

De novo exonic duplication of ATP1A2 in Italian patient with hemiplegic migraine: a case report

BackgroundSporadic Hemiplegic Migraine is a rare form of migraine headache. Mutations in three different genes, two ion-channel genes and one encoding an ATP exchanger, CACNA1A, ATP1A2 and SCN1A are all responsible for the FHM phenotype, thus indicating a genetic heterogeneity for this disorder. Here, we described a de novo exonic duplication of ATP1A2 in an Italian patient with Hemiplegic Migraine.Case presentationWe describe the case of a young woman (33 year old) who suffered from the age of 8 years of episodic weakness of the limbs, associated to other subjective and objective features. From aged 25, she developed neurological symptoms, like dizziness, blurred vision and an MRI scan revealed aspecific peritrigonal white matter hyperintensities. Aged 32 she suffered of right hemisomatic sudden-onset paresthesias, hypoesthesia and hyposthenia and the patient was genetically investigated for sporadic hemiplegic migraine.ConclusionsHere we report, for the first time, an exonic duplication in the ATP1A2 associated with hemiplegic migraine. The variation identified involves exon 21 of the ATP1A2 and is expected to alter the function of the alpha(2) subunit of the Na(+)/K(+) pump; the de novo nature of the duplication further supports its pathogenic role. To date, no other CNVs have been described in the ATP1A2 but only point mutations are reported. The novel mutation may result impaired M9 transmembrane domain, in a loss-of-function of the alpha(2) Na(+)/K(+)-ATPase with glutamate accumulation, alteration of synaptic function and neurotransmission.

Pilot survey of the health of Massachusetts dentists.

Dentistry is a career that is very rewarding because of the direct opportunity to deliver essential health services to patients in need. Dentistry is also very demanding; mentally, physically, and even emotionally. Little is known about the health of dentists and how it compares to the health of the general population. The aim of the present study was to report on the general health and health practices of dentists in Massachusetts. A medical health and health practices survey was developed from the Delaware Valley Community Health Center and customized. The surveys contained 36 questions relating to demographics, general health, and health practices. A total of 399 dentists completed the survey. Of those who responded to the survey, 78.2% were males, 32.6% were 56-65years of age, 23.1% were 66-75years of age, and 21.6% were 46-55years of age. This pilot study highlights several health issues where dentists seem to have a lower incidence than the general population: asthma, depression, diabetes, hearing loss, obesity, smoking, sleep apnea, and thyroid disease. However, there are some health issues where dentists have a higher incidence than the general population: taking at least one prescription medication, gastroesophageal reflux disease, some form of cancer, back pain, neck pain, headache, osteoarthritis, rheumatic arthritis, psoriatic arthritis, and alcohol abuse.

The Role of Adenosine Signaling in Headache: A Review.

Migraine is the third most prevalent disease on the planet, yet our understanding of its mechanisms and pathophysiology is surprisingly incomplete. Recent studies have built upon decades of evidence that adenosine, a purine nucleoside that can act as a neuromodulator, is involved in pain transmission and sensitization. Clinical evidence and rodent studies have suggested that adenosine signaling also plays a critical role in migraine headache. This is further supported by the widespread use of caffeine, an adenosine receptor antagonist, in several headache treatments. In this review, we highlight evidence that supports the involvement of adenosine signaling in different forms of headache, headache triggers, and basic headache physiology. This evidence supports adenosine A2A receptors as a critical adenosine receptor subtype involved in headache pain. Adenosine A2A receptor signaling may contribute to headache via the modulation of intracellular Cyclic adenosine monophosphate (cAMP) production or 5' AMP-activated protein kinase (AMPK) activity in neurons and glia to affect glutamatergic synaptic transmission within the brainstem. This evidence supports the further study of adenosine signaling in headache and potentially illuminates it as a novel therapeutic target for migraine.

Tension-Type Headache - The Normal and Most Prevalent Headache.

Tension-type headache (TTH) is the most prevalent form of primary headache in the general population but paradoxically the least studied headache. In this article, the epidemiology and diagnostic challenges of TTH are presented and discussed. The typical features and differential diagnosis of TTH are highlighted and the situations more likely to raise doubts are discussed. A structured approach to the patient and a better comprehension of the very frequent coexistence of migraine and medication overuse headache in the clinical population are emphasized. According to the IHS classification, several diagnoses should be applied but still some clinicians prefer to apply a single combined diagnosis in the severely affected patients, namely chronic migraine. Such uneven practice may complicate the diagnostic comparability and the entire management of TTH. The present treatment strategies for TTH are summarized and hopefully an increased awareness of TTH can translate into better quality of care and a more specific diagnosis and treatment for the numerous TTH sufferers.

Cerebral Venous Sinus Thrombosis- A Study of 4 Cases

Cerebral venous sinus thrombosis is an uncommon but important cause of stroke, especially in young-aged woman. Clinical presentation is variable, usually in the form of focal neurological deficit, seizure, headache and other features of raised intracranial pressure, leading to misdiagnosis or delay in treatment. Here we report 4 cases of venous sinus thrombosis with variable presentation. Diagnosis is confirmed by neuroimaging including magnetic resonance imaging with magnetic resonance venography of brain. Treatment consists of anticoagulation along with supportive management.&#x0D; Bangladesh Journal of Neuroscience 2017; Vol. 33 (1): 30-33

Diagnosis of refractory forms of chronic primary headache

A number of patients with primary headaches remain insensitive or refractory to treatment despite correctly selected drugs, adequate therapeutic dose and duration of therapy. The importance of refractory problem is determined by the fact that patients are completely maladjusted, disabled, and keeping these patients is very difficult even for seasoned professionals. Determination of the correct tactics and success of the treatment depends, in the first place, on the correct diagnosis. This article discusses the diagnostic criteria for the most important forms such as refractory chronic migraine or refractory chronic cluster headache presented by experts of the European Headache Federation in two separate Consensus.

A Simplified Parametric Study on Occupant Comfort Conditions in Base Isolated Buildings under Wind Loading

Vibrations in buildings can cause occupant discomfort in the form of annoyance, headache, or sickness. While occupant comfort is considered in international standards regarding the design of high rise buildings against wind loading, it is neglected in the design of buildings with seismic protective base isolation systems. Nevertheless, due to their low flexibility, base isolated buildings can be prone to wind-induced vibrations, which makes occupant discomfort a potentially significant serviceability limit state. This paper presents a study on occupant comfort conditions in wind-excited base isolated buildings. A numerical simplified parametric procedure is proposed in order to evaluate the return period of wind events causing human discomfort. A parametric investigation is then presented to evaluate the effects of salient parameters on comfort conditions. The procedure is based on (i) the nonlinear dynamic analysis of the structure modeled as a single-degree-of-freedom oscillator with hysteretic base isolators, (ii) the digital generation of time histories of turbulent wind velocity, and (iii) comfort evaluations based on international standards. Results demonstrate that discomfort conditions can occur a few times in a year, depending upon the wind-exposure of the site, what suggests considering this serviceability limit state in the design of base isolated buildings.

Trigeminal autonomic cephalalgias: a review

Trigeminal autonomic cephalalgias are a group of primary headache disorders presenting as unilateral pain in the somatic distribution of the trigeminal nerve, associated with ipsilateral cranial autonomic symptoms. This clinicopathologic group includes cluster headache, paroxysmal hemicrania, hemicrania continua and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/cranial autonomic features, which differ mainly as regards the duration and frequency of pain as well as response to treatment. These disorders are not as rare as they were thought to be and due to the severity of the pain can substantially affect the patients’ quality of life. Many other forms of primary headaches, such as migraine, trigeminal neuralgia and primary stabbing headache, as well as secondary headaches, particularly those caused by pituitary, posterior fossa, orbital, paranasal sinus and vascular pathology, need to be carefully considered in the diagnosis of trigeminal autonomic cephalalgias. Research in this field, particularly using functional neuroimaging, has resulted in a much better understanding of these disorders. Dysfunction in the nociceptive modulatory pathways in brain’s pain matrix is currently thought to produce a permissive state for the occurrence of a trigeminal autonomic cephalalgia attack, with posterior hypothalamus serving as a terminator rather than the generator of the attack. The current treatment strategies include medical and surgical approaches; of the latter, neuromodulation techniques, particularly deep brain stimulation of posterior hypothalamus, have proven to be particularly effective and promising.

57. Botulinum toxin type-A therapy in cluster headache: Two clinical cases

Cluster headache (CH) is a primary chronic disabling form with autonomic symptoms, that often does not respond satysfactorily to prophylactic treatment. Botulinum toxin type A is an effective therapy for chronic migraine. We describe 2 clinical cases of CH examining the role of Onabotulinum-toxin-A on this form of primary headache. We treated with Onabotulinum-toxin-A two men (46 and 65 years-old) with refractory CH, with a periodicity of 3–4 months, in the muscles of the head and neck following a Blumenfeld treatment paradigm. The first patient has undergone six applications of Onabotulinum-toxin-A (total dosage of 155 U-31 sites) with a follow-up of two years. The second patient has undergone ten applications of Onabotulinum-toxin-A (total dosage between 105 and 195 U-31-39 sites), with a follow-up of three years. Symptoms improvement appeared after the second infiltrative treatment in both case with persistence of effectiveness until seven treatment, with intensity and frequency attack reduction. The first patient reported rare episodes of temporo-mandibular joint tension. The second case showed a total cessation of attacks. Interleukin-1 is a potent prototypical pro-inflammatory cytochine implicated in the pathogenesis of CH, and botulinum toxin inactivate interleukin-1.Onabotulinum-toxin-A can represent a valid alternative prophylactic therapy in CH.

Widespread Pressure Pain Hypersensitivity Is Similar in Women With Frequent Episodic and Chronic Tension-Type Headache: A Blinded Case-Control Study.

To investigate differences in widespread pressure pain hyperalgesia in the trigemino-cervical and extra-trigeminal (distant pain-free) regions in women with frequent episodic (FETTH) and chronic (CTTH) tension-type headache. It seems that people with tension-type headache exhibit central sensitization. No study has investigated differences between FETTH and CTTH in terms of widespread pressure pain hypersensitivity. Forty-three women with FETTH, 42 with CTTH, and 45 women without headache diagnosis were recruited. Pressure pain thresholds (PPTs) were bilaterally assessed over trigeminal area (ie, temporalis muscle), extra-trigeminal (ie, C5/C6 zygapophyseal joint), and two distant points (ie, second metacarpal and tibialis anterior muscle) by a blinded assessor. Clinical features of the headache were collected with a 4-week headache diary. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). The ANCOVA revealed that PPTs were significantly decreased bilaterally over trigeminal (mean differences ranging from 97.5 to 101.5 kPa), extra-trigeminal (from 94.3 to 114.5 kPa), and distant points (from 99.4 to 208.6 kPa) in both FETTH and CTTH groups compared with controls (all, P < .001). No differences between FETTH and CTTH were observed (all points, P > .217). Anxiety (all, P > .803) or depression (P > .206) did not influence pressure pain hyperalgesia. No associations between widespread pressure hypersensitivity and headache features were observed (all, P > .110). Current results suggest the presence of similar local and widespread pressure hyperalgesia, not associated with anxiety or depression, in women with FETTH and CTTH supporting that localized and central manifestations are involved in both the episodic and chronic forms of tension-type headache.

Abnormal tyrosine metabolism in chronic cluster headache.

Objective Episodic cluster headache is characterized by abnormalities in tyrosine metabolism (i.e. elevated levels of dopamine, tyramine, octopamine and synephrine and low levels of noradrenalin in plasma and platelets.) It is unknown, however, if such biochemical anomalies are present and/or constitute a predisposing factor in chronic cluster headache. To test this hypothesis, we measured the levels of dopamine and noradrenaline together with those of elusive amines, such as tyramine, octopamine and synephrine, in plasma of chronic cluster patients and control individuals. Methods Plasma levels of dopamine, noradrenaline and trace amines, including tyramine, octopamine and synephrine, were measured in a group of 23 chronic cluster headache patients (10 chronic cluster ab initio and 13 transformed from episodic cluster), and 16 control participants. Results The plasma levels of dopamine, noradrenaline and tyramine were several times higher in chronic cluster headache patients compared with controls. The levels of octopamine and synephrine were significantly lower in plasma of these patients with respect to control individuals. Conclusions These results suggest that anomalies in tyrosine metabolism play a role in the pathogenesis of chronic cluster headache and constitute a predisposing factor for the transformation of the episodic into a chronic form of this primary headache.

Increased Amplitude of Thalamocortical Low-Frequency Oscillations in Patients with Migraine.

For many years, neurobiological theories have emphasized the importance of neuronal oscillations in the emergence of brain function. At the same time, clinical studies have shown that disturbances or irregularities in brain rhythms may relate to various common neurological conditions, including migraine. Increasing evidence suggests that the CNS plays a fundamental role in the predisposition to develop different forms of headache. Here, we present human imaging data that strongly support the presence of abnormal low-frequency oscillations (LFOs) in thalamocortical networks of patients in the interictal phase of migraine. Our results show that the main source of arrhythmic activity was localized to the higher-order thalamic relays of the medial dorsal nucleus. In addition, spontaneous LFOs in the thalamus were selectively associated with the headache attack frequency, meaning that the varying amplitude of dysrhythmia could predispose patients to recurrent attacks. Rhythmic cortical feedback to the thalamus is a major factor in the amplification of thalamocortical oscillations, making it a strong candidate for influencing neuronal excitability. We further speculate that the intrinsic dynamics of thalamocortical network oscillations are crucial for early sensory processing and therefore could underlie important pathophysiological processes involved in multisensory integration. In many cases, migraine attacks are thought to begin centrally. A major obstacle to studying intrinsic brain activity has been the identification of the precise anatomical structures and functional networks that are involved in migraine. Here, we present imaging data that strongly support the presence of abnormal low-frequency oscillations in thalamocortical networks of patients in the interictal phase of migraine. This arrhythmic activity was localized to the higher-order thalamic relays of the medial dorsal nucleus and was selectively associated with headache attack frequency. Rhythmic cortical feedback to the thalamus is a major factor in the amplification of thalamocortical oscillations, making it a strong candidate for influencing neuronal excitability and higher-level processes involved in multisensory integration.