Headache In Adults Research Articles

Improvement of morning headache in adults with obstructive sleep apnea after positive airway pressure therapy

The aim of this study was to evaluate the association between obstructive sleep apnea and morning headache and to assess the improvement of morning headache following positive airway pressure therapy. One hundred and sixteen participants were enrolled in this study; all of them received positive airway pressure therapy for at least 3 months. We checked the differences in various sleep apnea-related parameters according to the presence of morning headache and evaluated the improvement of morning headache following positive airway pressure therapy. Among the 116 study participants, 103 were men, with a mean age and body mass index of 50.34 ± 10.23 years and 28.00 ± 4.21 kg/m2, respectively. The severity of morning headache was higher in the severe obstructive sleep apnea group than in the mild to moderate group (2.16 ± 1.70 vs. 1.50 ± 1.57, P = 0.027). However, the various polysomnographic parameters did not significantly differ according to the presence of headache. The Epworth sleepiness scale score was significantly higher in the morning headache presence group than in the absence group (10.90 ± 5.45 vs. 8.13 ± 4.27, P = 0.003). Furthermore, a notable correlation was observed between the reduction in daytime sleepiness and the improvement in morning headache following PAP treatment (r = 0.503, P < 0.001). Morning headache significantly improved following positive airway pressure therapy (prevalence: 53.4–16.4%; severity: 1.92 ± 1.67 vs. 0.86 ± 0.80, all P < 0.001), especially in the patients with morning headache before positive airway pressure therapy. Morning headache is significantly associated with daytime sleepiness and positive airway pressure therapy improves morning headache.

Headache disorders and relevant sex and socioeconomic patterns in adolescents and young adults across 204 countries and territories: an updated global analysis.

Primary headache disorders are a group of highly prevalent and disabling neurological diseases that mainly consist of migraine and tension-type headache (TTH). A previous study showed that the burden of headaches peaked at a working age that ranged from 15 to 49, particularly among females, affecting their productivity and severely damaging their social interactions. The latest dataset was retrieved from the Global Burden of Disease (GBD) Study 2019. Three indicators, including prevalence, incidence, and years lived with disability (YLDs), were adopted for evaluation. The overall and specific headache burdens were fully compared and analysed at global, regional, and national levels. The ratio of female YLD rates to male YLD rates due to headaches was calculated to estimate the sex pattern. Finally, we utilized the two-tailed Spearman test to explore the potential association between socioeconomic background and headaches among young people. Globally, for overall headache disorders, a total of 2,049,979,883 prevalent cases (95% uncertainty interval (UI): 1,864,148,110 to 2,239,388,034), 601,229,802 incident cases (95% UI: 530,329,914 to 681,007,934), and 38,355,993 YLDs (95% UI: 7,259,286 to 83,634,503) were observed for those aged 10 to 54 in 2019. Sex differences were widely found for all headache types among adolescents and young adults, especially migraine. However, the most interesting finding was that the associations we tested between the socioeconomic environment and young headache patients were positive, regardless of region or specific country or territory. Overall, the global burden of headaches in adolescents and young adults largely increased from 1990 to 2019. Although slight declines were observed in sex differences, they remained significant and challenging. The positive correlations between headache and socioeconomic background among young people were relatively inconsistent with previous investigations, and several related hypotheses were proposed for explanation. Interdisciplinary actions involving education, policy- and law-making, and basic medical practice are desperately needed to further fight against the headache burden, promote gender equality in headache care, and eliminate the stigmatization of headache patients in student and working groups.

Association of Helicobacter pylori with migraine headaches and the effects of this infection and its eradication on the migraine characteristics in adults: A comprehensive systematic review and meta-analysis.

Migraine is one of the most common neurological disorders that can severely overshadow people's quality of life, and Helicobacter pylori infection is a health problem in different societies. During the last two decades, many original studies have been conducted on the various aspects of the relationship between these two disorders; however, they have reported different and sometimes contradictory results. This study was conducted based on the PRISMA protocol. We performed a comprehensive literature search in the online databases up to May 2023, and 22 studies that contained original data on the relationship between H. pylori infection and migraine headaches in adults were included. For performing the meta-analysis, we calculated the odds ratios (OR) and 95% confidence intervals (CI), using a random-effects model, and to determine the possible causes of heterogeneity, we conducted a subgroup meta-analysis. The overall OR for the association of H. pylori infection and migraine headaches through 493,794 evaluated individuals was 2.80 [95% CI = 1.75-4.48; I2 = 89.20, p < 0.01], which reveals a statistically significant association between these disorders. It was found that the studies that were conducted in Asian regions and the recently published ones have clearly shown a higher association between migraine and H. pylori infection. On the other hand, migraine patients who are infected with H. pylori have similar signs and symptoms as H. pylori-negative migraineurs; meanwhile, the clinical trials conducted in this field strongly emphasize the benefits of eradicating H. pylori infection in migraine patients and have estimated its effectiveness in improving migraine headaches equivalent to current common migraine treatments. Furthermore, it was reported that white matter lesions were 2.5-fold higher on brain MRI in patients with H. pylori-positive migraine compared with H. pylori-negative migraineurs; however, the evidence does not support the role of oxidative stress in patients suffering from H. pylori infection and migraine and refuses the role of Cag-A-positive strains of H. pylori in migraine headaches. According to the currently available data, it seem reasonable that patients with a definite diagnosis of migraine who also suffer from gastrointestinal problems, undergo the H. pylori detection tests and if the evaluations are positive, H. pylori eradication treatment can be considered even before any migraine treatment.

Rising trends in the burden of migraine and tension-type headache among adolescents and young adults globally, 1990 to 2019

BackgroundHeadache disorders are major contributors to disability in adolescents and young adults worldwide. We aimed to analyze global trends in the burden of migraine and tension-type headache in 10 to 24-year-olds from 1990 to 2019.MethodsData were obtained from the Global Burden of Disease Study (GBD) 2019 to examine trends in incidence, prevalence, and disability-adjusted life years (DALYs) for migraine and tension-type headache in adolescents and young adults by location, age, sex and sociodemographic index (SDI). Joinpoint regression analyzed trends and identified years of significant change.ResultsGlobally, migraine and tension-type headache incidence, prevalence, and DALYs increased from 1990 to 2019, though with some fluctuations. The highest growth in migraine incidence occurred in males and individuals aged 10-14, while for tension-type headache incidence, it was observed in males and individuals aged 20-24. Prevalence and DALYs were highest for both disorders in females and those aged 20–24 years. Incidence increased fastest in East Asia for migraine and tension-type headache. For migraine, Tropical Latin America had the fastest increase in prevalence and DALYs. East Asia had the fastest increase in prevalence of tension-type headache, while North Africa and the Middle East had the highest growth in DALYs. Some high-income countries such as Singapore, Norway, and Iran (Islamic Republic of) demonstrated fast increases, while a few countries including Qatar, Thailand and Ethiopia decreased.ConclusionsThe incidence, prevalence and disability from migraine and tension-type headache are rising in adolescents and young adults, especially in males, older youth and middle SDI populations. The increasing trends highlight the need for targeted interventions focused on prevention and control in priority populations. Continued monitoring of trends can help identify strategies to promote headache health and reduce the life-course impacts of headache disorders globally.

Association of obesity with headache among US children and adolescents: Evidence from NHANES 1999-2004.

Children and adolescents increasingly commonly suffer from obesity and headache. It has been confirmed that there is an association between obesity and headache in adults; however, evidence of such an association in paediatric populations is still controversial. Therefore, this study examined the relationship between obesity and headache among children and adolescents in the US. The cross-sectional data of 3948 participants were obtained from the National Health and Nutrition Examination Survey 1999-2004. Weighted logistic regression models were applied to investigate the association between obesity and headache. Subgroup analysis stratified by sex and age was performed to explore the potential difference in the association of paediatric obesity with headache. The performance of paediatric obesity on headache was assessed by receiver operating characteristic (ROC) curve. The present study involved 3948 participants, of whom 713 (18.1%) had headache. Compared to those without headache, participants with headache tended to be girls and adolescents, have less calcium intake, and have higher levels of body mass index (BMI), C-reactive protein (CRP), serum ferritin and triglycerides (TGs) (all P < 0.05). After fully adjusting for potential confounders, the ORs with 95% CIs for headache were 1.03 (0.58-1.54) and 1.25 (0.68-2.30) for overweight and obese participants in comparison with normal-weight controls, respectively, implying no association of paediatric obesity with headache independent of other potential confounding factors. In addition, although higher odds of headache were noted in girls and adolescents (aged 10-17 years), no statistically significant difference was found across any subgroups. The area under the ROC (AUC) of paediatric obesity on headache was 0.634. In summary, our study indicated that obesity is not associated with headache among US children and adolescents. Further prospective studies with larger sample size are needed to validate our findings.

DEPRESSION, ANXIETY, STRESS, AND HEADACHE IN BRAZILIAN OLDER PEOPLE IN THE CONTEXT OF THE COVID-19 INFODEMIC

Abstract Objective The aim of the present study was to analyze the prevalence and factors associated with headaches in Brazilian older people in the context of COVID-19 Infodemic. Methods This is a cross-sectional study carried out with 3,307 older Brazilians through a virtual questionnaire, self-completed using a cell phone, tablet, or computer with internet access. The questionnaire was composed of the Geriatric Depression Scale(GDS), Geriatric Anxiety Inventory(GAI), and the Perceived Stress Scale (PSS). Data collection was developed between June 2020 and January 2021. The analysis model consisted of variables distributed into four blocks: exogenous variables, primary determinants, health behaviors, and health conditions. It was used the Goodness-of-fit test to assess the quality of fit of the final model. Poisson regression with robust variance was used to estimate the associations. Results The prevalence of headache was 31.7% (CI 95%: 30 – 33). This outcome was associated with the use of psychotropic drugs (p &amp;lt; 0,001), concern with information about COVID-19(p &amp;lt; 0,001), symptoms of depression and anxiety(p &amp;lt; 0,001), and perception of stress(p &amp;lt; 0,001). Conclusion Anxiety, depression, and stress are thought to be associated with headaches in older adults who are exposed to excess information and fake news about COVID-19. It is considered that in the COVID-19 Infodemic scenario, headache in older people who have access to information is an important marker of mental health associated with suggestions of depression, anxiety, and stress.

The Influence of Selected Soft-Tissue and Telerehabilitation Techniques on Headaches in Young Adults During the COVID-19 Pandemic

Introduction: Headaches are a very common pain syndrome. The International Headache Society distinguishes primary pains, which include, among others, migraines and tension headaches, and secondary pain. Manual techniques, including soft tissue methods, are mentioned in the literature as an effective form of pain relief, but it is ambiguous whether manual therapy is a more effective form of headache therapy than exercises improving the flexibility of soft tissues in the neck area and cervical mobility. Objective: The aim of the study was to investigate the influence of selected techniques regarding working with soft tissues on headache symptoms. Material and methods: The study included 29 people with headaches, who were randomly divided into 2 groups. The study group, subjected to soft tissue techniques, comprised 15 people (13 women and 2 men), average age was 27.73 ± 5.06 years, body height, on average, 1.70 ± 0.08 cm, body mass, on average, 64.80 ± 12.31 kg. The control group, subjected to telerehabilitation, included 14 individuals (12 women and 2 men), average age was 28.36 ± 4.88, body height, on average, 1.68 ± 0.09 m, body mass, on average, 64.93 ± 12.78 kg. Participants were enrolled in the study after completing the questionnaire in which they reported currently experiencing headaches. The HIT-6 (headache impact test) and HDI (head disability index) screening tests were used to assess pain, and the results before and after the 3-week therapy were compared. In the study group, soft tissue therapy was performed in 3 sessions, for 30 minutes, 1 week apart. The control group was assigned self-therapy through teleconsultation in the form of exercises, at least 4 times a week, once a day, for 30 minutes, aimed at improving mobility of the cervical spine and elasticity of soft tissues. Results: In the study group, on the HIT-6 scale, the effect of pain on functioning prior to therapy was, on average, 61.87 ± 5.64, while at the end of therapy, a statistically significant decrease was observed – to an average of 48.60 ± 5.22 (p&lt;0.001). In the control group, on the HIT-6, the effect of pain on functioning was, on average, 59.00 ± 4.10, while at the end of the therapy, a significant decrease to the mean value was observed: 53.50 ± 6.04 (p&lt;0.01). For HDI, disability in the study group was at an average of 43.20 ± 19.78 before the therapy and 25.33 ± 14.32 (p&lt;0.01) following the therapy. In the control group, disability before and after the therapy was 31.43 ± 17.62 and 26.57 ± 13.73, respectively (p&lt;0.01). There were no statistically significant differences in the HDI results – 25.33 ± 14.32 for the study group and 26.57 ± 13.73 for the control group (p&gt;0.05) after treatment. Conclusions: Soft tissue therapy and telerehabilitation caused a significant reduction in the impact of headaches on daily functioning and disability. In the era of epidemics, telerehabilitation may be an effective treatment for headaches in young adults.

Neurological manifestations in patients and disease carriers in an Italian family with osteosclerosis.

Hereditary cranial hyperostosis is a rare disease never described in Italy, so the neurological manifestations in patients and carriers of the disease have been little studied. We describe the neurological and neuroimaging features of patients and carriers of the gene from a large Italian family with sclerosteosis. In this family, genetic testing detected the homozygous p.Gln24X (c.70C > T) mutation of the SOST gene in the proband and a heterozygous mutation in 9 siblings. In homozygous adults, severe craniofacial hyperostosis was manifested by cranial neuropathy in childhood, chronic headache secondary to intracranial hypertension, and an obstructive sleep apnea syndrome in adults. In one of the adult patients, there was a compressible subcutaneous swelling in the occipital region caused by transosseous intracranial-extracranial occipital venous drainage, a compensation mechanism of obstructed venous drainage secondary to cranial hyperostosis. Mild cranial hyperostosis causing frequent headache and snoring was evident in the nine heterozygous subjects. Multiple cranial neuropathies and headache in children, while severe chronic headache and sleep disturbances in adults, are the neurological manifestations of the first Italian family with osteosclerosis. It is reasonable to extend neurological and neuroimaging evaluation to gene carriers as well.

Ahead of the pain: Where we stand after a decade of growth in United Council for Neurologic Subspecialties-certified headache subspecialists.

To characterize the geographic distribution of United States (US) headache subspecialists in 2021 compared to 2012 and analyze trends in distribution of and growth by geography. Headache disorders are the second-highest cause of disease burden worldwide. Historically, headache disorders have been treated by primary care and emergency physicians, often suboptimally. Our 2012 study identified further disparities in geographic distribution of United Council for Neurologic Subspecialties (UCNS)-certified headache subspecialists. This correlational population study explores the current geographic distribution of and changes in subspecialists by aggregating data from the UCNS, National Health Interview Survey, US Census, Bureau of Economic Analysis, and American Community Survey. In 2021, there were 692 UCNS-certified headache subspecialists. There continued to be higher subspecialist density in the Northeast (1:34,678) and Midwest (1:55,005), with the highest density in Vermont (1:12,510) and Connecticut (1:20,419). The highest absolute subspecialist increases were in the South (99), California (35), and Texas (25). The highest relative subspecialist increases were in the West (105%), Vermont (500%), and Mississippi (500%). The univariable regressions showed significant associations between number of subspecialists and adult headache population (R2 =0.797, p < 0.001), between subspecialist density and personal income (R2 =0.935, p=0.033), and between growth in subspecialists and poverty rate (R2 =0.553, p=0.022). However, the multivariable regressions showed that only the adult population was significantly associated with number of subspecialists (adjusted R2 =0.806, p < 0.001). Overall, there has been substantial growth in the number of UCNS-certified headache subspecialists in the US, especially relative to growth in adult headache population. Subspecialist density continues to be highest in the Northeast and is associated with higher per capita personal income. However, there has been encouraging growth in geographies that previously had little to no access. These findings represent positive progress, but there is more to be done to both increase access to optimal headache care by subspecialists nationally and decrease geographic disparities in access to care.

Association of Acute Headache of COVID-19 and Anxiety/Depression Symptoms in Adults Undergoing Post-COVID-19 Rehabilitation

As a common non-respiratory symptom of COVID-19, headache should not be overlooked, and its characteristics should be recorded with scrutiny. Identifying risk factors associated with post-COVID headache will ensure immediate action and counseling for this population of patients. Therefore, the study aimed to investigate the relationship between headache and psychological state (stress level, depression, and anxiety symptoms) in adults undergoing post-COVID-19 rehabilitation. In addition, we used mediation analysis to evaluate the mediation effect of psychological variables in the relationship between headache and quality of life. This cross-sectional study included 147 patients undergoing post-COVID-19 rehabilitation at the Public Hospital in Poland (64 males, 83 females, with mean age of 56.97 years). Psychological parameters were evaluated using the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale (PSS-10), and the brief World Health Organization Quality of Life Scale (WHOQOL-BRIEF). Additionally, all participants completed a questionnaire related to COVID-19 symptoms and their severity, the place of COVID-19 treatment, and the need for oxygen therapy during hospitalization. Of all participants, 65% experienced headache during COVID-19. Of the participants with headache, there were significantly more females in this group (69% vs. 31%), and they were significantly younger (mean age 55.47 vs. 59.78 years). Participants with headache had a 27% higher HADS-D score, a 21% higher HADS-A score, and a 13% higher PSS-10 score. Moreover, gender and headache were found to be important predictor variables for total HADS and HADS-D, accounting for 11% and 7%, respectively. Mediation analysis has shown that the tested psychological variables mediated 39–68% of the total effect of headache influence on WHOQOL domains. In conclusion, our study demonstrated several relationships between headache that occurred during COVID-19 and symptoms of depression, anxiety, and perceived stress level during post-COVID rehabilitation also in the context of quality of life. Our results show that patients who experienced headaches during COVID-19 are at high risk of developing anxiety-depressive symptoms later. Female gender is associated with a higher prevalence of headache during COVID-19.

Dysbiosis and Migraine Headaches in Adults With Celiac Disease.

One of the most significant illnesses associated with gluten is celiac disease, which encompasses many conditions. It is generally recognized that neurological manifestations can occur either at the time of the disease onset or as the illness continues to develop. One of the main clinical presentations of celiac disease is headache, either in the form of migraine or in an unspecific form. Migraine pathophysiology is intricate and still poorly understood. Several mechanisms involving the gut-brain axis have been proposed to explain this association. These include the interaction of chronic inflammation with inflammatory and vasoactive mediators, the modulation of the intestinal immune environment of the microbiota, and the dysfunction of the autonomic nervous system. However, further research is required to fully comprehend the fundamental mechanisms and pathways at play. This review aims to give a narrative summary of the literature on celiac disease's neurological symptoms, particularly migraines, and to assess any potential associations to dysbiosis, an imbalance in the microbiome.

A study of cardiac autonomic functions in patients with chronic migraine versus chronic Tension-type Headache (TTH) in adults cardiac autonomic functions in headache

Objective: To assess cardiac autonomic functions in patients with chronic migraine and chronic tension-type headache (TTH) in adults using heart rate variability (HRV). Methods: Two groups of patients having chronic migraine (n = 25) and chronic TTH (n = 25) were enrolled for this study. HRV was analyzed with the help of BIOPAC MP150. Statistical analysis was performed with SPSS version 21. Unpaired t-test and Mann-Whitney test were used for parameters with normal and nonnormal distribution, respectively. Results: In chronic migraine group, SDNN (38.90 ± 22.14 vs 41.71 ± 20.81 ms, p=1.000), RMSSD (39.20 ± 25.14 vs 64.11 ± 156.74 ms, p=0.437) and pNN50 (13.37 ± 17.94 vs 18.56 ± 20.42, p=0.496) were lower than in chronic THH group. Frequency domain parameters like LF (614.20 ± 604.89 ms2 vs 595.81 ± 597.08 ms2, p=0.823) and HF (1190.68 ± 1330.87 ms vs 832.52 ± 1356.70 ms2, p=0.148 were higher for chronic THH group compared to chronic migraine group. The total power for chronic THH group was higher compared to chronic migraine group (2447.93 ± 2215.03 ms2 vs 1845.27 ± 1550.38 ms2, p=0.308).

Clinical availability of SNOOP4 in acute non‐traumatic headache patients admitted to the emergency department

Objectives:Non‐traumatic headache accounts for up to 4.5% of all patients presenting to the emergency department. Non‐traumatic headache is generally classified into two categories: primary and secondary headache disorders. Differentiating secondary from primary headache disorders is essential. SNOOP4 is known as a mnemonic for suggesting clinicians send neuroimaging to rule out serious conditions. Yet, the benefit of using this mnemonic in the emergency department is not well established. This study aimed to assess the significance of SNOOP4 in detecting serious causes of non‐traumatic headache in adults presenting to the emergency department.Methods:We conducted a prospective observational study of adult patients presenting to the emergency department of the single tertiary hospital over a period of 12 months. Patients with acute non‐traumatic headache presented at the emergency department were included. A standard record form was used. Patients were investigated and treated following the pre‐existing protocols. Results were interpreted by attending radiologists. Each factor, according to SNOOP4, was then evaluated for the ability to predict serious causes of non‐traumatic headache.Results:A total of 90 patients were included in this study with complete details obtained on 83 (92.2%) patients. Of these, 63 (75.9%) were female. The mean age was 44.5 years (inter‐quartile range: 27–58.5). The duration of the headache ranged from 10 min to 7 days. Out of 83, 27 (32.5%) had at least one SNOOP4 criterion. In all, 25 patients (30.1%) underwent neuroimaging. The sensitivity, specificity, positive predictive value, and negative predictive value of SNOOP4 were 77.8%, 73.0%, 25.9%, and 96.4% respectively.Conclusion:SNOOP4 criteria show very high negative predictive value for excluding serious causes of acute non‐traumatic headache in adult patients presenting to the emergency department.

Characteristics and comorbidities of headache in patients over 50\xa0years of age: a cross-sectional study

BackgroundAlthough headache is a common complaint in younger individuals, it is one of the most common complaints among persons over the age of 50 and is a significant cause of morbidity. As there are differences in the causes and types of headache, the diagnosis and management of headache in older adults differ from that in younger individuals.MethodsIn this cross-sectional study, 570 patients ≥ 50 years were recruited at a university affiliated tertiary headache center between 2016 and 2019. Demographic data, headache characteristics, and comorbid medical conditions were recorded. The presence of depression was explored using the Beck Depression Inventory. The patients were evaluated using the STOP-BANG scale to determine the risk of obstructive sleep apnea.ResultsThe mean age of the patients was 57.7 years. Seventy-three percent of the patients had primary headache disorders, with the most prevalent types being migraine, followed by tension-type headache. Secondary headaches were primarily the result of overuse of medication, cervical spine disease, and hypertension. Patients with medication-overuse headache were significantly more likely to suffer from hypothyroidism and gastrointestinal problems such as bleeding/ulcers. Irritable bowel syndrome was also more common in patients with medication-overuse headaches and migraines. The risk for obstructive sleep apnea was intermediate in 45.2% of the patients with hypertension-induced headache, but was lower in the majority of others. There was a high tendency for moderate-to-severe depression in the participants; however, the Beck Depression Inventory scores were significantly higher in medication-overuse headache patients.ConclusionProper treatment of headache in middle-aged and older adults requires the recognition of secondary causes, comorbid diseases, and drug induced or medication overuse headaches. Special attention should be paid to depression and obstructive sleep apnea in such patients suffering from headache disorders.

The role of perinatal factors in the development of primary headaches in children

In both children and adult patients, migraine and tension type headache (TTH) are the most common primary headaches, they affect about 15% and 21% of the world’s population, respectively. The role of genetic, psychosocial, hormonal factors is traditionally considered in the genesis of primary headaches. Obviously, neurobiological factors including early brain damage, genetic predisposition are involved in the formation of the pathophysiological basis of primary headaches, which interact with a complex of other factors, including external (psychosocial) factors, leading to changes in the pain mechanisms both at the peripheral and central levels. The literature review presents up-to-date data on the influence of pre- and perinatal factors on the risk of developing primary headaches. Intrauterine growth retardation, smoking and alcohol consumption by mothers during pregnancy are analyzed as risk factors for the development of migraine in children. The connection between the manifestations of increased neuroexcitability in children in the first 6 months with the development of primary headaches in subsequent periods of life is considered. The data of comparison of the results of the assessment of early anamnesis in clinical groups of patients with frequent episodic and chronic TTH are presented. The review examines the possible mechanisms of functional disorders of the nervous system that lead to the occurrence of primary headaches in the future. It is necessary to continue research on the role of perinatal factors in the genesis of primary headaches, to clarify the prognosis regarding the possible chronization of pain syndromes and develop differentiated approaches to the treatment tactics for these patients.

Epidemiology of Moyamoya Angiopathy in Eastern India.

IntroductionMoyamoya angiopathy (MMA) is a chronic, progressive intracranial vasculopathy with variation in prevalence and clinical manifestations across different populations. This study was aimed to estimate the frequency of MMA as an etiology of stroke and its epidemiological features in the largest cohort of MMA patients in India.MethodA single-centered cross-sectional observational study over a period of 5 years (2016–2021) was undertaken among consecutive stroke and transient ischemic attack (TIA) patients to look for the presence of MMA angiographically. Each patient with angiographically proven MMA was further evaluated for demographic, clinical, and radiological characteristics.ResultsAmong 10,250 consecutive stroke and TIA patients (ischemic = 78%, hemorrhagic = 22%), frequency of MMA was 1.56% (n = 160); 15.3% among children. Female preponderance (Male:Female = 1:1.4) was noted among 160 MMA patients, with bimodal age distribution, first peak at 3–8 years, and a shorter second peak at 41–47 years. Childhood-onset MMA was seen in 75 (46.9%) with commonest initial neurological symptom of fixed-motor-weakness (44.0%), followed by TIA (26.7%); while 85 (53.1%) had adult-onset MMA with fixed-motor-weakness (50.6%) followed by headache (24.7%) as the predominant initial neurological symptom; seizure significantly higher in children (p < 0.001) and headache in adults (p = 0.012). Transient and fixed neurological manifestations constituted 87.5 and 69.4% respectively, of symptoms throughout the disease course. Cerebral infarction (45.0%) and TIA (21.9%) were the commonest types of MMA. On brain imaging, infarction was noted in 80.6%, hemorrhage in 11.3%, significantly higher among adults (p < 0.001). Cortical infarct and Gyral pattern were commoner in children (p = 0.004), subcortical infarcts in adults (p = 0.018). Frequent Suzuki staging observed was stage 4 (31.3%), followed by stage 3 (30.0%). Involvement of posterior circulation was detected in 55.6%, brain atrophy at the time of diagnosis was seen in 65.0%.ConclusionMMA is an important etiological consideration in patients with stroke, especially in children. It can present with a myriad of transient neurological symptoms, frequently overlooked, leading to delayed diagnosis, and contributing to socio-economic burden. Indian MMA showed aberrations in its gender predisposition, age distribution, frequency of familial cases, disease manifestation, and type of stroke, in comparison to its Japanese and Caucasian counterparts pointing to the inter- and intra-continent differences of MMA phenotype. Future development of the Indian MMA national registry is of essence.

Introducing a Special Issue of Biofeedback Magazine

In 2001, AAPB and ISNR joined hands to establish a Task Force to develop guidelines for the evaluation of clinical efficacy in biofeedback and neurofeedback. Theodore LaVaque et al. (2002) published the Task Force report, creating an efficacy rating scale for biofeedback and neurofeedback interventions. The efficacy rating runs as follows, based on the credibility of current published research on specific disorders:Since that time, AAPB has published three editions of the book Evidence-Based Practice in Biofeedback and Neurofeedback (Yucha & Gilbert, 2004; Yucha & Montgomery, 2008; Tan et al., 2016). Each edition of these books has carefully reviewed the emerging published research on the various application areas for biofeedback, from adult headache to urinary incontinence, using widely respected authors, and rating each application's efficacy according to the current evidence for efficacy. Over the 18 years since the first edition, the published research has grown and improved in many areas, resulting in improved efficacy ratings for several disorders.The Evidence-Based series provides a handbook for clinicians who wish to consider biofeedback or neurofeedback for a new client's condition, and a reference source for referring physicians.Currently, AAPB is preparing to publish a fourth edition of Evidence-Based Practice in Biofeedback and Neurofeedback, with a new editorial team including Inna Khazan, Fredric Shaffer, Randy Lyle, Saul Rosenthal, and Donald Moss. The next two issues of Biofeedback magazine will include chapters from that upcoming fourth edition. This issue opens with a chapter by Donald Moss, summarizing the abundant research on both biofeedback and neurofeedback interventions for posttraumatic stress disorder (PTSD). Based on the evidence for therapeutic benefit, supported by a growing number of randomized controlled trials on both biofeedback and neurofeedback, the chapter rates biofeedback and neurofeedback as Level Four – Efficacious for PTSD.Next, this special issue includes a chapter by Sarah Prinsloo on the newer and still emerging research on neurofeedback for chemotherapy-induced peripheral neuropathy (CIPN). Prinsloo reviews two randomized controlled trials and one case study on neurofeedback for CIPN and rates this application area as Level Four – Efficacious.This issue also includes a Letter to the Editor from Eric Willmarth, Cynthia Kerson, Richard Sherman, and Jerry Devore. Their letter is a response to an article by Mari Swingle in the Fall 2021 issue of Biofeedback. The four begin by applauding Mari Swingle for emphasizing the importance of well-trained and well-informed providers in providing appropriate neurofeedback services. However, they take issue with her minimizing the need for randomized controlled trials and discounting the use of placebo controls. Their letter highlights controversies in the field and central issues in clinical biofeedback and neurofeedback research.Erik Peper and Richard Harvey provide an article describing a treatment protocol for a first-session psychophysiological assessment for abdominal nausea and gastrointestinal discomfort. Their assessment uses the physiological recording to identify possible mechanisms for the illness, such as abdominal muscle tension, autonomic activation, and stressful thoughts. The authors emphasize the importance of providing the client with a clear understanding of the psychophysiological processes at play. Peper and Harvey also use this initial session to give the individual beginning experiences of self-regulation, for example, showing a patient how diaphragmatic breathing modifies her overactivated physiology.

The rationality of recommendations of drugs for patients with cephalgia in simulated situations in the pharmacy

Relevance. According to statistics of the World Health Organization, at least half of the world’s adult population experienced headaches at least once a year. Patients suffering from headaches do not always have the opportunity to visit a doctor, therefore, an important role in helping these patients is assigned to pharmacists. Purpose. Based on the pharmacoepidemiological study to identify the features of providing pharmaceutical care to patients with headache in pharmacies in the issue of rationality of recommendations of pharmaceutical workers. Materials and methods. A pharmacoepidemiological study was conducted based on a survey of 153 pharmaceutical workers (Saratov) using a specially developed questionnaire that includes free-form questions with a simulated situation. The data was processed using Microsoft Excel 2010 and STATISTIKA 6.0. Results Of the groups recommended to visitors, INNs in the group «Nonsteroidal anti-inflammatory and antirheumatic drugs [M01A]» account for 45.0 % of all INNs, and the group «Analgesics [N02]» - 55.0 %. Ibuprofen (62.8 %) and the combination of drotaverine + caffeine + naproxen + paracetamol + phenylephrine (41.2 %) were noted as the most frequently recommended. A visit to a doctor was recommended by the majority of respondents (52.3 %, n=153) in the case of a patient with a headache accompanied by nausea and vomiting. Ibuprofen (90.8 %) or paracetamol (45.8 %), moreover in the form of suspension or suppositories, are the preferred recommendations for headache in children under 3 years of age (n=131). Paracetamol in combinations (69.2 %) prevails as the first recommendation for headache associated with acute respiratory viral infections (n??=146). Non-selective NSAIDs for a patient with gastrointestinal complications could be recommended by 43.4 % of specialists (n=113). The NSAID recommendation is the most frequent (51.8 %, n=110) in the case of an 80-year-old patient without concomitant diseases. Paracetamol (50.0 %) or ibuprofen (34.7 %) would be more often recommended by pharmaceutical workers for a pregnant woman with headache (n=98). In case of headache after trauma, 47.1 % recommend a visit to a doctor (n=153). Conclusion. The frequent recommendation of combined analgesics and their association with the development of drug-induced headaches indicates the need for careful recommendation of these drugs. Not always correct recommendations indicate the need to increase the level of professional knowledge, study clinical recommendations for the therapy and diagnosis of cephalgia, which can make it possible to make a rational choice of the drug, initially assume that the visitor has conditions that require a visit to a doctor, and ultimately improve the quality of pharmaceutical care.

Characterization of persistent post-traumatic headache and management strategies in adolescents and young adults following mild traumatic brain injury

Characteristics of persistent post-traumatic headache (PTH) in young individuals are poorly known leading to diagnostic problems and diverse management. We aimed to describe headache phenotypes and self-reported management strategies in young individuals with PTH following mild traumatic brain injury (mTBI). A comprehensive structured questionnaire was used to evaluate headache phenotypes/characteristics and management strategies to relieve headache in 107, 15–30-year-old individuals with PTH. Around 4 months post-injury, migraine-like headache in combination with tension-type like headache (40%) was the most commonly encountered headache phenotype followed by migraine-like headache (36%). Around 50% reported aura-like symptoms before/during the headache attack. Medication-overuse headache was diagnosed in 10%. Stress, sleep disturbances, and bright lights were the most common trigger factors. More than 80% reported that their headache was worsened by work-related activity and alleviated by rest/lying down. Simple analgesics were commonly used (88%) whereas prophylactic drugs were rarely used (5%). Bedrest and physiotherapy were also commonly used as management strategies by 56% and 34% of the participants, respectively. In conclusion, most young individuals with PTH after mTBI presented with combined migraine-like and tension-type-like headache followed by migraine-like headache, only. Preventive headache medication was rarely used, while simple analgesics and bedrest were commonly used for short-term headache relief.

Olfactory Dysfunction, Headache, and Mental Clouding in Adults with Long-COVID-19: What Is the Link between Cognition and Olfaction? A Cross-Sectional Study.

Smell alteration and cognitive impairment are common features of the Long-COVID Syndrome. Mental clouding, often described as brain fog, might affect smell by altering recollection of odors or through a share mechanism of neuroinflammation. We investigated mental clouding, headache, and cognitive function in adult patients with persistent COVID-19 olfactory dysfunction. This multi-center cross-sectional study enrolled 152 adults with self-reported olfactory dysfunction from 3 tertiary centers specialized in COVID-19 olfactory disorders. Inclusion criteria were smell alterations after COVID-19 persisting over 6 months from infection, age >18 and < 65. Exclusion criteria included smell alterations, headache, or memory problems prior to COVID-19 infection. The patients were evaluated by olfactometry, nasal endoscopy, headache scale, cognitive assessment, Mini Mental State Examination (MMSE), and self-reported measures. Smell dysfunction was stratified and classified based on olfactory deficit severity and presence of olfactory distortion (parosmia, cacosmia). Data on smell disorder, mental clouding, MMSE, and headache were analyzed to assess correlations. Among the 152 patients studied, 50 (32.8%) presented with anosmia, 25 (16.4%) with hyposmia, 10 (6.6%) with parosmia/cacosmia, and 58 patients (38.2%) with a combination of hyposmia and parosmia; seven (4.6%) patients suffered from headache exclusively, and two (1.4%) had headache and mental clouding as their primary symptom. Headache was reported by 76 (50%) patients, and mental clouding by 71 (46.7%). The patients reporting headache, mental clouding, or both, had significantly increased risk of suffering from anosmia and/or hyposmia when compared with their counterparts without these neurological symptoms. No patients had reduced MMSE scores. In our cohort of adult patients with post-COVID-19, smell alterations persisting over 6 months, cognitive impairment and headache were associated with more severe olfactory loss, consistent with neuroinflammatory mechanisms mediating a variety of Long-COVID symptoms.