History Of Headache Research Articles

An unusual presentation of orbital rhabdomyosarcoma: A case report

Orbital rhabdomyosarcoma (RMS) is the commonest orbital cancer in children. Capillary hemangioma (CH) is the commonest benign periorbital tumor in childhood. We present an unusual case of orbital RMS, which was initially diagnosed as an orbital CH. An 8-year-old girl presented with a right eye protrusion of 3 years’ duration. The protrusion increased with the Valsalva maneuver. There was no history of headache, remarkable weight loss, or swelling of any other parts of the body. A diagnosis of orbital hemangioma was made, and she was commenced on propranolol with some improvement, but she defaulted. When she was represented 4 years later, there was a huge mass surrounding the right eye, with blindness and intermittent bleeding. Orbital computed tomographic angiography revealed features of a very vascular mass with bony expansion of all the orbital walls. She underwent modified exenteration, and her histology revealed Alveolar RMS. These reports highlight an unusual presentation of orbital RMS.

The Chronic Headache: A Case Challenge

The patient with a history of frequent headaches presents to her primary care provider for evaluation. Although the review of symptoms is consistent with her typical headache, the physical examination leads the nurse practitioner to consider alternative differential diagnoses and reprioritize her plan of care. This case challenge requires the reader to remain vigilant in the examination of patients with common somatic complaints, such as headache, and delve deep into the patient’s history to arrive at an accurate diagnosis.

Increased screen time and its association to migraine and tension-type headache: a cross-sectional investigation among Bangladeshi students

BackgroundIncreasing prevalence of screens among young people is a notable characteristic of the modern digital era. The study aimed to explore the prevalence and associated factors of migraine headache (MH)...

Outcome of Surgery in Ruptured Aneurysm: A Study of 48 Cases

Background : Rupture aneurysm is a dangerous clinical condition of a patient. The aim of this study is to find out the outcome of rupture aneurysm after microsurgical clipping. Method: This was a prospective cross sectional study and was conducted at the department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2011 to April 2022. Results : Among 48 patient 30(62.5%) were male. It was documented that 32(66.6%) patients were belong to 51-60 years. It was evident that the most of the clinical presentation was history of sudden severe headache 48(100%), 32(66.6%) patients had presented with vomiting and brief loss of consciousness had 24(50%). The highest percentage of WFNS grading of during admission were (1-3), 32(66.6%). Peroperative rupture during surgery were 16(33.33%). During discharge good recovery was occurred 38(79.7%) and 5(10.5%) had death. Conclusion: We have treated all the case by microsurgical clipping. Still microsurgical clipping is one of the gold standard procedure for rupture intracerebral aneurysm. Bang. J Neurosurgery 2023; 12(2): 114-121

Temporary Peripheral Nerve Stimulation for the Treatment of Greater Occipital Neuralgia

BACKGROUND: Greater occipital neuralgia (GON), a cause of chronic headaches, can be debilitating and vastly affect one’s quality of life. Recent strides in comprehending the pathophysiology of GON and the ongoing evolution of approaches to the condition’s treatment have led to the pursuit of more effective interventions. Among these, temporary peripheral nerve stimulation (PNS) devices have surfaced as an avenue for management, presenting a minimally invasive yet highly efficient alternative in treating other chronic pain conditions. This study discusses a case of GON successfully managed with temporary (60-day) PNS. CASE REPORT: A 35-year-old man presented with a nearly 8-month history of intractable headaches without any inciting event along the left greater occipital nerve distribution. The patient underwent a series of 2 diagnostic GON blocks and experienced 90% pain relief. A 60-day PNS device was implanted to treat the patient’s left-side GON, and during the 6-month period, the patient received 75% pain with no complications. CONCLUSIONS: Temporary PNS is a promising treatment for painful mononeuropathies. Most PNS devices are implanted permanently to provide benefits, but this new development allows temporary stimulation devices to manage chronic pain. This case demonstrates another potential therapeutic option for pain management providers to alleviate pain in patients suffering from GON. KEY WORDS: Peripheral nerve stimulation, occipital neuralgia, chronic headache, neuromodulation, pain medicine

Pediatric torticollis: clinical report and predictors of urgency of 1409 cases

BackgroundTo date, the etiology and risk factors of torticollis are still poorly defined in the pediatric literature. Especially in the Emergency Department (ED) scenario, it is critical to reliably distinguish benign and transient conditions from (potentially) life-threatening disorders. This study describes the clinical characteristics of a large sample of children with torticollis. The aim of our study was to detect epidemiology, etiology and predictive variables associated with a higher risk of life-threatening conditions in acute torticollis.MethodsWe conducted a pediatric retrospective study of acute torticollis over a 13-year period referred to the ED of a tertiary pediatric Hospital. We reported the characteristics in the overall sample and in two subgroups divided according to urgency of the underlying condition. Furthermore, we developed a multivariate model aimed at identifying the main clinical predictors of the need for urgent care.Results1409 patients were analyzed (median age 5.7 years, IQR 5.8). A history of trauma was present in 393 patients (27.9%). The symptom most frequently associated with torticollis were pain (83.5%). At least one pathological finding was found in 5.4 to 7.9% of patients undergoing further imaging. Hospitalization was required in 11.1% of cases (median duration 4 days). The most frequent etiologies of torticollis were postural cause (43.1%), traumatic (29.5%), and infective/inflammatory (19.1%). A longer time from onset of torticollis and the presence of headache or vomiting were strongly correlated with an underlying urgent condition, after adjusting for the other clinically and statistically significant variables in the bivariate analysis.ConclusionOur study shows that an urgent condition most commonly occur in patients presenting with history of trauma or headache, vomiting and torticollis for more than 24 h should undergo further diagnostic evaluation and short-term follow-up, restricting invasive or expensive investigations to patients with clinical suspicion of an underlying harmful condition.

E035 Tocilizumab and the reversible cerebral vasoconstriction syndrome

Abstract Background/Aims Reversible cerebral vasoconstriction syndrome (RCVS) describes a group of conditions characterised by thunderclap headache and radiographic evidence of multifocal cerebral artery vasoconstriction. While typically following a benign course to resolution within a period of days to weeks, a small proportion of patients experience complications such as stroke, seizure or cerebral oedema. While a wide range of aetiological factors have been implicated in the clinical literature, there is, to our knowledge, only one prior publication reporting an association between tocilizumab and RCVS. Methods Here, we describe the case of a patient who developed RCVS following treatment with tocilizumab for rheumatoid arthritis. Results A 41 year old lady presented to her local emergency department after waking from sleep with sudden onset thunderclap headache with associated photophobia and vomiting. There was no prior history of headache. Her past medical history included rheumatoid arthritis and depression. At time of admission, her prescribed medications included folic acid, sertraline, methotrexate and tocilizumab. For the past 5 years, her rheumatoid arthritis had been controlled with a combination of methotrexate and etanercept, but, with her disease flaring, the etanercept was switched for tocilizumab six weeks prior to admission. Initial evaluation with CT head, CT venogram and lumbar puncture did not reveal any underlying abnormalities. A subsequent CT angiogram of the head and neck revealed multiple smooth stenoses bilaterally within the anterior cerebral arteries (ACA), middle cerebral arteries (MCA) and posterior cerebral arteries (PCA). A diagnosis of RCVS was made and tocilizumab was discontinued. Conclusion In patients taking tocilizumab, particular consideration should be given to the possibility of RCVS when performing a diagnostic evaluation of thunderclap headache. Tocilizumab may be an aetiological factor in this condition and its discontinuation may prevent the development of more serious complications. Disclosure B. Corney: None. C. Rhys-Dillon: None.

E032 Low dose methotextrate induced leukoencephalopathy: a case report

Abstract Background/Aims Methotextrate is a widely used disease modifying anti-rheumatic drug (DMARD) used to treat connective tissue disorder and inflammatory arthritis. Methotextrate induced neurological toxicity includes vomiting, headaches, blurred vision, mood alteration, somolescence, brain fog, hyperosmia, leukoencephalopathy and pseudo-stroke like syndrome. Here we report a case of methotextrate induced headache with leptomeningeal enhancement, which reversed after stopping the methotextrate. Methods A 66 year old male with known diagnosis of sero-positive rheumatoid arthritis with past medical history of Hodgkins lymphoma in remission. He started on dual DMARD combination of 15 mg methotextrate subcutaneously once a week and 200 mg hydroxychlroquin twice daily. Thereafter he reported history of headaches, which needed hospital admission. He underwent a CT-head scan on admission which did not show any acute concerns. The case was then discussed with the haematology team and later he underwent a PET scan of the whole body which was reviewed in Lymphoma MDT which showed non-specific uptake in hilar nodes, which does not significantly increase the suspicion of lymphoma relapse. On discharge he had MRI head contrast and MRV cerebral veins, which showed a few areas of irregular nodular curvilinear foci of predominantly meningeal enhancement noted in occipital lobes and adjacent T2 /flair hypertense signal noted in relation to these. These changes were discussed in neurology MDT, given the history of lymphomas a possibility, though rare in the absence of systemic relapse. The differential included low dose (oral) methotextrate related neurotoxicity. Patient was advised to stop methotextrate, they repeated MRI scan 3 weeks later which showed disappearance of the curvilinear lesions with leptomeningeal enhancement and patient reported headaches improved. Results List of investigations 1. CSF- profile, no protein, no growth 2. CSF PCR panel for Adeno/Paracheo/Entero/Varicella Zoster/HSV type 1&2-negative 3. Histology report of CSF- No evidence of lymphoma 4. Neuronal Ab: Purkinje cell/ Hu Ab/Ri Ab amd Anti-amphiphysin Ab-negative 5. Myeloma screen- no paraprotein detected 6. Virus panel- EBV- IgM-, HIV /Hep B and C, Cytomegalovirus IgM-not detected. Conclusion Methotextrate is a potent anti-metabolite preventing the formation of tetrahydrofolate, and used as immunosuppressant and anti-neoplastic medication. Though the exact mechanism of the neurotoxicity is not known, the common hypothesis include; interference with myelin synthesis or maintenance and/or interference with neurotransmitter synthesis. The case reported here reiterates the importance of recognizing the neurological side effects in patients on methotextrate even on low dose of methotextrate. It also emphasizes the fact that the neurological changes are reversible on stopping methotextrate. Headaches can still be a side effect and might mimic stroke like episode in patients treated with low dose of subcutaneous methotextrate and hence stopping the medication should be considered in such cases. Disclosure P. Doddamani: None. A. Kinder: None.

Epidemiology and clinical characteristics of headache among COVID-19 patients in Lebanon: a retrospective cohort study

BackgroundWith the spread and rise in the number of infections of COVID-19 globally, patients experienced neurologic manifestations such as headache and dizziness, along with other serious medical conditions such as stroke and seizures. Many reported cases highlighted headache to be one of the most common COVID-19-related neurological symptoms. With the evolution of the pandemic, broad studies are needed to better understand the mechanism of headache with COVID-19. The aim of this study is to recognize the epidemiology, characteristic and progression of headache among patients with COVID-19 in Lebanon.MethodsA retrospective cohort study was done to assess 439 patients for headache during the course of COVID-19. The Statistical Package for Social Sciences (SPSS) version 26 was used for descriptive analysis.ResultsA confirmed COVID-19 Infection by PCR test was confirmed among 86% of the participants. Tension-like headache was the most common type of headache experienced by participants during COVID-19. Pain was mainly diffuse (48.7%), and compressing in nature (77.0%). Moreover, about 29% required a physician consultation and 7.7% had emergency visits. Partial relief by analgesics was reported in 54.9%, and mainly by paracetamol (64.6%). Those who reported having a history of primary headache before contracting COVID-19 were 46.7%. Among them, 36.7% patients reported a change in the type of headache and about 49.6% reported increased severity.ConclusionHeadache accompanied with COVID-19 is a common symptom during the early stages of illness. COVID-19 related headache was characterized as mainly involving the whole head region, pressuring, and partially relieved by analgesics. Thus, headache should raise early concern for the probability of being infected by COVID-19.

Lack of habituation of visual-evoked potential in the interictal period is not a consistent neurophysiological marker of migraine: A cross-sectional analytical study

Objectives: Migraine is a frequent incapacitating neurovascular illness characterized by severe headache bouts. Individuals suffering from migraine appear to process auditory and visual information differently from those without migraine. The visual-evoked potential (VEP) is a commonly used standardized test to measure excitability in the occipital cortex. Patients with migraine exhibit amplification rather than habituation of stimulus-induced brain responses, between attacks. Our objective is to compare the amplitude of P100 and the latencies of N75, P100, and N145 (N and P represent negative and positive peaks, respectively, with average latency being subscripted with the alphabet) in the fourth block between migraine patients and controls and to determine the various clinical factors associated with the P100 mean amplitude and latency differences between the first and the fourth block in migraine patients. Materials and Methods: The study compared 20 migraine patients (with or without aura) and 20 apparently healthy subjects with no history of migraines or secondary headaches, focusing on the habituation of the VEP. Four blocks of 200 responses were recorded during the headache-free period, and the latencies and amplitudes of N75, P100, and N145 components were analyzed. Results: There was a statistically significant (P < 0.05) decrement in the P100 amplitude in the fourth block when compared to the first block in both eyes in the controls as well as migraine patients. In addition, there was no statistically significant difference between controls and migraine sufferers in the P100 amplitude of the fourth block in either eye. The N145 latency in the fourth block was shorter in both eyes in migraine patients compared to controls (P < 0.05). The mean P100 amplitude difference between the first and fourth block correlated negatively with age and positively with headache frequency, while there was a moderate negative correlation with headache duration. The mean P100 latency difference between the first and fourth block correlated positively with age and negatively with headache frequency, while there was a moderate positive correlation with headache duration. Conclusion: In our study, VEP habituation was not lacking in migraine patients which means that habituation of the P100 wave was noted in migraineurs. The VEP reveals neurological changes due to ischemia injury or neurotransmitter imbalances. Migraine alters cortical excitability, but it is unclear if these changes are due to altered excitatory connections, damaged inhibitory networks or subcortical pre-activation. Our findings suggest that at least during the interictal period, lack of habituation cannot be employed as a consistent neurophysiological marker of migraine across laboratories.

Primary intracranial peripheral primitive neuroectodermal tumor: lessons from an exceptionally rare neoplasm. Illustrative case.

The primary intracranial peripheral primitive neuroectodermal tumor (pPNET) is a lesion subtype within the Ewing sarcoma family of tumors. pPNETs are extremely uncommon pathologies, accounting for 0.03% of intracranial tumors and 1% to 2% of Ewing sarcoma cases. Given its histological aspect similar to other highly proliferative malignant neuroectodermal neoplasms, pPNET merits extensive workup for accurate diagnosis and treatment. A 36-year-old male presented to the emergency department with a 1-year history of headaches in the right frontoparietal area, generalized tonic-clonic seizures, and a history of the resection of a tumor labeled as a meningioma 5 years before admission. He was neurologically intact. Brain magnetic resonance imaging revealed a heterogeneous focal lesion of 25 × 35 × 23 mm with a necrotic center and neoformative appearance in the right frontal cortex. The patient underwent multimodal treatment with gross-total resection, radiotherapy, and chemotherapy. Histopathological examination results supported the diagnosis of pPNET. At the 2-year follow-up, the patient had no new-onset symptoms, and brain imaging revealed absent signs of tumor recurrence. The present case describes an extraordinary pPNET case, initially confounded as a clear cell meningioma. Managing pPNET requires thorough investigation, careful differentiation from similar neuroectodermal lesions, and multimodal treatment to improve the patient's prognosis.

Pineal Gland Epidermoid cyst, a rare Tumor

Background: Intracranial epidermoid cysts, forming 1% of adult and 3-8% of pediatric brain tumors, are among the rarest of intracranial neoplasms. Originating from ectodermal remnants retained during embryonic development, pineal epidermoid cysts are rare benign tumors that often manifest as obstructive hydrocephalus due to midbrain tectum compression. Objective: To report on the clinical presentation, diagnostic process, and surgical management of a pineal epidermoid cyst in a young adult, emphasizing the role of ventriculoperitoneal shunting and the outcomes of surgical intervention. Methods: A case study of a 20-year-old male presenting with a 4-month history of occipital headaches and vertigo, without seizures, neurological deficits, or visual disturbances. Diagnostic evaluation included brain imaging that revealed hydrocephalus secondary to a pineal space-occupying lesion. A ventriculoperitoneal shunt was placed for obstructive hydrocephalus treatment prior to the surgical excision of the pineal lesion. Results: The patient underwent a ventriculoperitoneal shunting procedure, followed by a suboccipital transtentorial craniotomy 2 months later, leading to the complete resection of the pineal space-occupying lesion. The histopathological analysis confirmed the diagnosis of a pineal epidermoid cyst. Post-surgical follow-up indicated significant symptomatic improvement with no recurrence observed. Conclusion: Pineal epidermoid cysts, while rare, can significantly impact patient well-being through the development of obstructive hydrocephalus. Early intervention with ventriculoperitoneal shunting followed by surgical resection can lead to favorable outcomes. Long-term monitoring is essential to ensure there is no recurrence.

Frequency and Clinical Features of Space Headache Experienced by Astronauts During Long-Haul Space Flights.

Few anecdotal cases and 1 small retrospective study during short-duration space missions suggest that headache may occur early in flight, as part of the space motion syndrome. Whether headaches may also occur at later stages of space flights is unknown. We aimed to prospectively characterize the incidence, timing, clinical features, and management of space headaches during long-duration flights. We prospectively evaluated the occurrence, characteristics, and evolution of space headaches and the effects of treatment and countermeasures during long-haul flights with onboard questionnaires and correlated them with prevailing temperature, pressure, and ambient O2 and CO2 levels, measured within the International Space Station. In addition, we analyzed retrospective headache data from a different astronaut cohort. Headache data were reported using descriptive statistics and correlation data with intraindividual logistic regression models. Astronauts were included through (inter)national aerospace organizations. In the prospective study, 22/24 (91.7%) astronauts (mean ± SD age: 46.6 ± 6.5 years, 95.8% male) experienced ≥1 episode of headache during a total of 3,596 space days. A total of 378 episodes were reported (median 9; range 1-128) with detailed information on 189. Phenotypically, 170/189 (89.9%) episodes were tension-type headache (TTH) and 19/189 (10.1%) were migraine. Episodes in the first week differed from those in later periods in terms of phenotype (migraine 12/51 [23.5%] vs 7/138 [5.1%]; TTH 39/51 [86.5%] vs 131/138 [94.9%]; overall p = 0.0002) and accompanying symptoms: nausea: 17.6% vs 6.9%, p = 0.05; vomiting: 9.8% vs 0.7%, p = 0.005; nasal congestion: 52.9% vs 29.7%, p = 0.004; facial edema: 41.2% vs 1.4%, p < 0.001; and duration (p = 0.001). Severity and treatments were similar: acute antiheadache medication: 55.6%; other medication: 22.4%; and alternative treatments: 41.1%. Headache occurrence was not associated with temperature or ambient pressure/levels of O2 and CO2 (all p > 0.05). In the retrospective study, 23/42 (54.8%) astronauts (43.5 ± 7.2 years, 90.5% male) reported experiencing ≥1 headache episode during mission. Nasal congestion was the most common (8/33; 24.2%) accompanying symptom. Seventeen of 42 astronauts have been previously described. Astronauts during space flights frequently experience headaches. These most often have characteristics of TTHs but sometimes have migrainous features, particularly during the first week of flight in astronauts without a history of recurrent headaches before or after the space flight.

Acute invasive fungal sinusitis with orbital tip syndrome in patients on long-term use of ruxolitinib: a case report

IntroductionA long-term ruxolitinib-treated patient with primary myelofibrosis, who was co-infected with aspergillosis infection during a short period, developed acute invasive fungal sinusitis with consequent orbit apex syndrome. This may be the first reported case in the world.This is a 75-year-old Chinese man; the patient was admitted with 2-month history of headache accompanied by numbness and 8-day history of vision loss. The preliminary clinical diagnoses were suspected acute invasive fungal sinusitis or adenoid cystic carcinoma. We performed endoscopic debridement and antifungal therapy. About 90 days after surgery, magnetic resonance imaging revealed no recurrence of pathological tissue.ConclusionOne of the bases for the occurrence of invasive fungal sinusitis may be the patient’s long-term use of ruxolitinib for essential thrombocythemia. Some patients with invasive fungal sinuses have atypical nasal symptoms and are referred to the corresponding departments with eye and headache as the first symptoms. It is suggested that enhanced magnetic resonance imaging should be performed at an early stage. Surgical treatment in combination with antifungal and enhanced immunotherapy can effectively prevent the spread of infection and reduce the risk of death.

Headache to a Patient with the Coexistence of Chiari I Malformations and Primary Empty Sella Syndrome: A Case Report la Syndrome: A Case Report

Background: Chiari I malformations (CM-I) and Primary Empty Sella syndrome (PESS) are rare disorders of structural defects within a skull. Headache is the most common presenting symptom in both conditions. However, CM-I and ESS comorbidity in patients with severe headaches is yet to be reported. Case description: The patient was a 38-year-old woman with a one-year history of headaches at various localisations (occipital and bilateral frontal) preceded by mood agitation. Physical examination was significant for obesity. Magnetic resonance imaging (MRI) revealed a 6.4 mm cerebellar tonsil descent through the foramen magnum and hypointense (CSF-filled) flattened sella. The lipid panel showed elevated cholesterols (total) and low-density lipoprotein (LDL) levels. She was medically managed, with no report of symptoms relapses at one-month and two-month follow-ups. Conclusion: This is the first report on comorbid CM-I and PESS in adults presenting with cephalalgia. PESS and CM-I co-occurrence may present with mixed headache localisation; careful history-taking and imaging are mandatory for diagnosis confirmation. Future extensive studies are warranted to analyse the pathophysiological interplay between these two rare disorders.

Cryptococcus Infection in an Immunocompetent Patient

A case of a 26-year-old female who was apparently healthy without any comorbidities presented with a history of headache, which was gradually progressive over 2 months with features suggestive of raised intracranial pressure. Cerebrospinal fluid (CSF) study was done, which revealed chronic meningitis. Indian ink staining of CSF showed Cryptococcus, and the species was identified as Cryptococcus gattii. She did not have any respiratory symptoms, but the chest radiography showed a consolidative patch caused by growing yeasts mimicking a mass. Cryptococcal infection is rarely seen in immunocompetent individuals. Among the two species of Cryptococcus, C. gattii is known to cause infections in immunocompetent. It is imperative to have a high index of suspicion and early diagnosis of such a condition to avoid unwanted complications in patients.

Implementation Of Relaxation Therapy Listening To Music In Hypertensive Patients

Background : Hypertension causes the aorta and large arteries to reduce their ability to accommodate the volume of blood pumped by the heart, resulting in a decrease in heart rate. To overcome a decrease in cardiac output, this is by providing classical music therapy. Objective: This study aims to find out the description of nursing care for patients with reduced cardiovascular function and hypertension with the implementation of music listening therapy. Methods: This research was conducted using a case study. Results: The results of the assessment showed that the client said he had a history of hypertension, felt headache, shoulder and leg pain, was worried about his illness, and tired quickly. A nursing diagnosis of acute pain, ineffective health care and obesity was obtained. The intervention is by providing music therapy and health education. Conclusion: After carrying out these actions, the results showed that the problem of pain and health maintenance, while the problem of obesity was partially resolved. The evaluation results showed blood pressure in the range of 130/90 mmHg.

Intracerebral Haemorrhage after Illicit Use of Sildenafil: A Case Report

Sildenafil(viagra) has become one of the top selling over the counter product for the treatment of male erectile dysfunction.(1) We report a case of 34year male patient admitted in our ICU with history of severe headache followed by sudden loss of consciousness after ingestion of two tablets of sildenafil(50mg) land up intracerebral bleed and died. There are many cases in the literature reporting intracerebral or subarachnoid haemorrhage associated with use of sildenafil while sexual contact.

A Case of Asymmetrical Vogt-Koyanagi-Harada Disease in a Patient with Ota Nevus Following Laser Treatment

Purpose: To report a case of Vogt-Koyanagi-Harada (VKH) disease exhibiting asymmetric symptoms, predominantly in the affected eye, aside from the bilateral findings noted in indocyanine green angiography (ICG) in a patient who had undergone treatment for nevus of Ota.Case summary: A 33-year-old male presented with decreased visual acuity, ocular pain in the right eye, and a 3-week history of headache. The patient had undergone two laser treatments at 1-month intervals to address a nevus of Ota on the upper and lower eyelids and the maxillary area of the right side. He had no notable medical history. Fundus examination and optical coherence tomography indicated multiple serous retinal detachments. ICG displayed multiple hyperfluorescent spots in both eyes. Given these findings, the patient was diagnosed with VKH disease, predominantly affecting the right eye. Human leukocyte antigen (HLA) testing revealed the presence of the HLA-DRB1*09 and HLA-DQB1*03 (DQ8) alleles. The patient initially received high-dose intravenous steroid therapy, later transitioning to oral steroids. After a month of treatment, the serous retinal detachments had resolved and his vision improved. No signs of recurrence were evident during a 6-month follow-up.Conclusions: VKH disease can manifest asymmetrically, especially in the eye affected after laser treatment for nevus of Ota. Despite potential monocular presentation, it is crucial to assess for binocular involvement through comprehensive examinations.

Increased prevalence of migraine in women with inflammatory bowel disease: A cross-sectional study.

Some studies have suggested an association between migraine and inflammatory bowel disease. We determined migraine prevalence in a cohort of patients with inflammatory bowel disease. Patients with inflammatory bowel disease aged 18-65 years were interviewed using an ad hoc headache questionnaire. Those who admitted a history of headache in the last year answered the three questions of the ID-Migraine questionnaire. Those who answered "yes" to the three of them were classified as "definite" and those who answered "yes" to two were classified as "probable" migraine. We interviewed 283 patients with inflammatory bowel disease. Of these, 176 (62.2%) had headache. Fifty-nine (20.8%; 95% CI 16.3-26.0%) met migraine criteria either definite (n = 33; 11.7%; 95% CI 8.2-16.0%) or probable (n = 26; 9.2%; 95% CI 6.1-13.2). When divided by gender, 12 men (9.6%; 95% CI 5.1-16.2%) and 47 women (29.8%; 95% CI 22.8-37.5%) met migraine criteria. The prevalence of migraine was increased in inflammatory bowel disease patients from the current cohort (20.8%) versus that reported for our general population for the same age group (12.6%; p < 0.0001). These differences remained significant in female inflammatory bowel disease patients (29.8% versus 17.2% in our general population; p < 0.0001), but not in males (9.6% in inflammatory bowel disease vs 8.0%; p = 0.30). Seventeen patients with inflammatory bowel disease (6.0%; 95% CI 3.54-9.44%) fulfilled chronic migraine criteria. There were no differences in migraine prevalence by inflammatory bowel disease subtypes. Migraine prevalence, including chronic migraine, seems to be increased in patients with inflammatory bowel disease. The fact that this association was stronger for women suggests an influence of sex-related factors.