Prolonged Headache Research Articles

A Mixed Methods Analysis of Long COVID Symptoms in Black Americans: Examining Physical and Mental Health Outcomes.

While several reports confirm that long COVID is associated with poorer health, few studies explore how long COVID directly impacts the lives of Black Americans who experienced higher mortality rates early in the pandemic. Even fewer studies utilize both quantitative and qualitative methods to identify pertinent long COVID symptoms. The current study, therefore, sought to identify points of overlap and divergence when comparing qualitative vs. quantitative descriptions of long COVID experiences among Black adults in the United States. We analyzedcross-sectional surveys collected from the AmeriSpeak panel through the National Opinion Research Center (NORC) at the University of Chicago. This panel includes a probability-based sample of adults across the UnitedStates. Respondents completed online surveys between April and June 2022. We compared outcomes among participants who reported experiencing post-acute sequelae of COVID-19 (i.e., long COVID) to those who reported experiencing SARS-CoV-2 without long COVID. Nearly all qualitative responses focused on matters of physical health like prolonged coughing, cardiovascular concerns, troubled breathing, fatigue, headaches, memory loss, and bodily pains. Quantitative results, however, showed that Black adults living with long COVID reported significantly more anxiety, depressive symptoms, and hopelessness. Persons with long COVID were also significantly more likely to report experiencing psychosis, suicidal ideation, suicide plans, and suicide attempts within the last year. Black adults with long COVID experienced worse outcomes across all mental health measures. Despite the COVID-19 Public Health Emergency expiration in May 2023, urgent efforts are still required to not only treat both the physical and mental health needs of persons living with long COVID, but to effectively prevent the spread and transmission of COVID-19.

Emergency department CT scan utilization and findings in geriatric patients presenting with non-traumatic headache

Background & Objective: In geriatric patients, headache is a common reason for emergency department (ED) visits. Because secondary headaches are more common in geriatric patients than in younger patients, the former should be carefully excluded at presentation. In this study, we aimed to investigate the role of brain computed tomography (CT) in geriatric patients presenting to the ED with non-traumatic headache, the indications for imaging, the CT findings, and factors associated with detection of pathology. Methods: Patients aged 65 years and older who presented to the ED with headache between January 1, 2023 and December 31, 2023, who underwent a brain CT scan, and who had complete data were included in the study. Patients with an intracranial mass, acute-subacute ischemic findings, intraparenchymal and subarachnoid hemorrhage, and cerebral edema on brain CT scan were considered as having significant pathology. Results: The study included 384 patients. CT scan was normal in 61.2% of the patients and 10.4% had significant pathology. It was observed that 24.5% of the patients underwent CT scan for prolonged headache and 19.3% for severe headache. Logistic regression analysis showed that severe headache, loss of consciousness, anticoagulant use, neurological deficit, and elevated blood pressure at presentation were predictors of the detection of significant pathology on CT scan. Conclusion: In conclusion, 10.4% of geriatric patients presenting to the emergency department with headache have significant CT findings, and the impact of these findings on the emergency management of patients cannot be ignored. Incorporating these findings into clinical decision-making guidelines could improve the effectiveness of emergency management protocols by facilitating rapid and specific diagnostic interventions for geriatric patients presenting with headache.

American Headache Society white paper on treatment of post-traumatic headache from concussion in youth.

To provide healthcare professionals guidance on youth at risk for prolonged recovery and post-traumatic headache (PTH), and on pharmacologic and non-pharmacologic management of PTH due to concussion and mild traumatic brain injury. Headache is the most common persistent post-concussive symptom affecting 8% of youth for >3 months after concussion. Over the past decade, many studies have explored the treatment of PTH in youth, but there are no established guidelines. This white paper is based on a synthesis of an updated systematic review of the literature on treatment of PTH and a narrative review of the literature on risk factors for prolonged recovery and health disparities. Results were interpreted by a group of expert providers in PTH in children and adolescents through collaboration of the PTH and pediatric special interest groups of the American Headache Society. Factors that consistently were associated with prolonged recovery from concussion and persistent PTH included female sex, a high number of acute symptoms, and adolescent age. Social determinants of health also likely play an important role in PTH and deserve consideration in the clinical and research settings. A total of 33 studies met the criteria for inclusion in the systematic review of PTH treatment in youth, although most were retrospective and of fair-to-poor quality. Treatment strategies included acute and preventive pharmacologic management, procedures, neuro-modulatory devices, physical therapy, physical activity, and behavioral health support. A collaborative care approach that includes a thoughtful combination of these management strategies is likely most effective. This white paper provides a roadmap for tailoring the treatment of PTH based on factors influencing prolonged headache, the timing of therapies, and therapies with the most evidence for treating PTH in youth. We also highlight research needed for developing more definitive guidelines on PTH management in youth.

Hubungan Kecanduan Gawai dengan Kejadian Insomnia pada Mahasiswa Fakultas Kedokteran Universitas Muhammadiyah Surabaya

Insomnia is a condition characterized by difficulty falling asleep, staying asleep, or waking up early despite having the opportunity to sleep. Insomnia can reduce the quality and quantity of sleep, leading to various negative effects on an individual's health and well-being. One of the potential causes of insomnia is excessive smartphone use, which can lead to addiction. Smartphone addiction can affect people of all ages, from children to adults. It has been associated with several adverse effects, including insomnia, recurrent and prolonged headaches, and fatigue. This study aimed to investigate the relationship between smartphone addiction and insomnia among medical students at the University of Muhammadiyah Surabaya. This cross-sectional observational study involved 87 medical students from the 2019, 2020, 2021, and 2022 cohorts. The sample was selected using a proportionate stratified random sampling technique. Data were collected using the Smartphone Addiction Scale (SAS) and the Insomnia Rating Scale (KSPBJ-IRS) through a Google form. The data were analyzed statistically using the Chi-square test in SPSS version 25. The Chi-square test showed a p-value of 0.005 (<0.05), indicating a statistically significant relationship between smartphone addiction and insomnia among medical students at Muhammadiyah University of Surabaya. In conclusion, the study found a significant relationship between smartphone addiction and insomnia among medical students at Muhammadiyah University of Surabaya. This suggests that excessive smartphone use may contribute to sleep disturbances in this population.

Exploring the link between pediatric headaches and environmental noise exposure

BackgroundHeadaches are the most common neurologic symptoms in the pediatric population. Most primary headache in children and adolescents focuses on associated factors, including noise. Auditory discomfort is related to recognizing the pain. We aimed to analyze the headache profile of pediatric populations and the connection between noise exposure and head pain in children and adolescents.MethodsWe reviewed retrospectively medical records of the pediatric population with headaches in Gyeongsang National University Changwon Hospital from January 2022 to April 2023. Personal headache profiling from self-questionnaires and environmental noise data from the National Noise Information System (NNIS) were used to analyze each variable, and chi-square tests and linear regression models by SAS were used to analyze the statistical correlation.ResultsOf the 224 participants, 125 were clinically diagnosed with headaches. Of the 104 pubertal subjects, 56.7% were diagnosed with headaches, compared to 60% in the prepubertal group. Both daytime and nighttime noise was significantly higher in the diagnosed headache group than in the non-diagnosed group. Headache duration increased by daytime and nighttime noise with statistical significance in age-adjusted models.ConclusionWe found that noise exposure is correlated to headaches in children and adolescents. Daytime and nighttime environmental noise exposure was significantly associated with the duration of headaches through our data. Therefore, we assume that noise exposure is vitally relevant to prolonged headaches in the pediatric population. Further research is needed to improve our data.

Prolonged headache with vaccine- and dose-specific headache pattern associated with vaccine against SARS-CoV-2 in patients with migraine.

To examine SARS-CoV-2 vaccine-related headache characteristics and risk factors in migraine patients. This retrospective cohort study included 732 migraine patients who had AstraZeneca Vaxzevria, Pfizer-BioNTech Comirnaty, or Moderna Spikevax vaccines. Participants provided information through questionnaires and headache diaries. Headache frequency before and after vaccination and factors associated with headache risk were examined. Approximately a third of patients reported increased headache the day after having primary and booster doses, with mean increase ± SD of 1.9 ± 1.2 and 1.8 ± 1.1 days/week, respectively. Proportions of migraine patients with headache (after vaccination vs. before vaccination) increased after having primary-dose Vaxzevria (35.3% vs. 22.8%, p < 0.001) but not Spikevax (23.8% vs. 26.7%, p = 0.700) or Comirnaty (33.2% vs. 25.8%, p = 0.058). Headache proportion increased after having all three boosters (Vaxzevria 27.1% vs. 17.9% p = 0.003; Comirnaty 34.1% vs. 24.5% p = 0.009; Spikevax 35.2% vs. 24.8% p = 0.031). For primary dose with Vaxzevria and Comirnaty, headache risk increased on the vaccination day, peaked on the day after vaccination, and subsided within a week, while for Spikevax headache risk rose gradually after vaccination, peaked on the seventh post-vaccination day and subsided subsequently. For booster dose, headache risk generally increased on the vaccination day, peaked on the day after vaccination, and subsided gradually with fluctuating pattern within a month. Our study also showed that headache increased on the day before primary dose but not booster dose vaccination and it may be attributable to stress associated with having to undertake new vaccines. Multivariable analyses showed that depression was associated with headache. Prolonged headache with vaccine- and dose-specific headache pattern was found. Patients with higher risks of vaccine-related headache must be informed of the potential worsening headache.

Alternative prosthetic approach in the management of flabby edentulous anterior maxilla: A case report and literature review

Abstract A flabby ridge is a condition where excessively mobile and resilient tissue affects the maxillary or mandibular alveolar ridges. This study reviews the flabby anterior maxillary ridges and explores their management. It also included a case report of a 67-year-old male diabetic patient with rare manifestations in the anterior maxilla. The selection of this patient in this study was due to the rare flabby tissue manifestations in the anterior maxilla. These manifestations resulted in denture instability and loss of retention but also caused significant symptoms for the patient, including severe pain, prolonged headaches, and a burning sensation. This study aimed to alleviate pressure on the flabby tissues in the anterior maxilla and enhance the complete denture’s retention, support, and stability. In managing the flabby anterior maxilla described in this study, the prosthetic approach involved utilizing a modified window technique for the secondary impression and a low-viscosity impression material. On the following day till the follow-up period (12 months), the patient showed no complaints of pain, headache, or burning sensation, and the complete denture was in good retention, support, and stability. Prosthodontic management is a reliable alternative to surgery for hypermobile flabby tissues. It improves denture quality, reduces pressure, and enhances comfort and functionality during daily activities.

Mathematical Psychiatry: On Cortical Spreading Depression-A Review.

The concept of migraine with aura (MwA) is a widespread condition that can affect up to 30% of migraine patients and manifests itself as a temporary visual illusion followed by a prolonged headache. It was initially pitched as a neurological disease, and observed that the spread of accompanying electrophysiological waves as part of the condition, which came to be known as cortical spreading depression (CSD). A strong theoretical basis for a link between MwA and CSD has eventually led to knowledge of the dynamics between the pair. In addition to experiment-based observations, mathematical models make an important contribution towards a numerical means of expressing codependent neural-scale manifestations. This provides alternate means of understanding and observing the phenomena while helping to visualize the links between the variables and their magnitude in contributing towards the emanation and dynamic pulsing of the condition. A number of biophysical mechanisms are believed to contribute to the MwA-CSD, spanning ion diffusion, ionic currents of membranes, osmosis, spatial buffering, neurotransmission, gap junctions, metabolic pumping, and synapse connections. As part of this review study, the various mathematical models for the description of the condition are expressed, reviewed, and contrasted, all of which vary in their depth, perspective, and level of information presented. Subsequent to this, the review looked into links between electrophysiological data-driven manifestations from measurements such as EEG and fMRI. While concluding remarks forged a structured pathway in the area on sub-themes that need to be investigated in order to strengthen and robustify the existing models, they include an accounting for inter-personal variability in models, sex and hormonal factors, and age groups, i.e., pediatrics vs. adults.

Characteristics of headaches attributed to SARS-CoV-2 vaccination and factors associated with its frequency and prolongation: a cross-sectional cohort study.

Headache is the most frequent neurological adverse event following SARS-CoV-2 vaccines. We investigated the frequency, characteristics, and factors associated with post-vaccination headaches, including their occurrence and prolongation (≥ 48 h). In this observational cross-sectional cohort study, retrospective data collected between April 2021-March 2022 were analyzed. Univariate and multivariate logistic regressions were used to evaluate the effect of clinicodemographic factors on the odds of post-vaccination headache occurrence and prolongation. Of 2,500 people who were randomly sent the questionnaire, 1822 (mean age: 34.49 ± 11.09, female: 71.5%) were included. Headache prevalence following the first (V1), second (V2), and third (V3) dose was 36.5, 23.3, and 21.7%, respectively (p < 0.001). Post-vaccination headaches were mainly tension-type (46.5%), followed by migraine-like (36.1%). Headaches were mainly bilateral (69.7%), pressing (54.3%), moderate (51.0%), and analgesic-responsive (63.0%). They mainly initiated 10 h [4.0, 24.0] after vaccination and lasted 24 h [4.0, 48.0]. After adjusting for age and sex, primary headaches (V1: aOR: 1.32 [95%CI: 1.08, 1.62], V2: 1.64 [1.15, 2.35]), post-COVID-19 headaches (V2: 2.02 [1.26, 3.31], V3: 2.83 [1.17, 7.47]), headaches following the previous dose (V1 for V2: 30.52 [19.29, 50.15], V1 for V3: 3.78 [1.80, 7.96], V2 for V3: 12.41 [4.73, 35.88]), vector vaccines (V1: 3.88 [3.07, 4.92], V2: 2.44 [1.70, 3.52], V3: 4.34 [1.78, 12.29]), and post-vaccination fever (V1: 4.72 [3.79, 5.90], V2: 6.85 [4.68, 10.10], V3: 9.74 [4.56, 22.10]) increased the odds of post-vaccination headaches. Furthermore, while primary headaches (V1: 0.63 [0.44, 0.90]) and post-COVID-19 headaches (V1: 0.01 [0.00, 0.05]) reduced the odds of prolonged post-vaccination headaches, psychiatric disorders (V1: 2.58 [1.05, 6.45]), headaches lasting ≥48 h following the previous dose (V1 for V2: 3.10 [1.08, 10.31]), and migraine-like headaches at the same dose (V3: 5.39 [1.15, 32.47]) increased this odds. Patients with primary headaches, post-COVID-19 headaches, or headaches following the previous dose, as well as vector-vaccine receivers and those with post-vaccination fever, were at increased risk of post-SARS-CoV-2-vaccination headaches. Primary headaches and post-COVID-19 headaches reduced the odds of prolonged post-vaccination headaches. However, longer-lasting headaches following the previous dose, migraine-like headaches at the same dose, and psychiatric disorders increased this odd.

Brucellosis Masquerading as Disseminated Tuberculosis: A Clinical Case Report.

Human brucellosis is a common zoonotic disease in certain regions of the world, especially in rural populations, yet it is often neglected. The index patient presented with prolonged fever and headache. Examination revealed hepatosplenomegaly, and investigations revealed transaminitis with bicytopenia with serological evidence positive for Brucella. The radiological picture suggested granulomatous disease with miliary nodules, and a bone marrow examination revealed a noncaseating granuloma. The case was unique and challenging, as the clinical picture was consistent with epidemiologically prevailing tuberculosis, which is also seen in brucellosis-endemic countries. Brucellosis mimicked disseminated tuberculosis, making the case intriguing to diagnose and treat. The case demonstrated that physicians need to have a high index of suspicion for brucellosis, which should be actively investigated in cases with prolonged fever. It also illustrated the fundamental importance of teamwork and the centrality of the multidisciplinary team in the planning and prioritization of treatment.

Pott's Puffy Tumor in Pediatric Patients: Case Series and Literature Review.

Pott's puffy tumor (PPT) is a rare complication of frontal sinusitis. Although it may occur at any age, the incidence is higher during adolescence. We report a series of 10 pediatric patients (9-17 years of age) who presented with PPT in 2 tertiary care pediatric hospitals in central Israel between January 2018 and August 2022 and review the published literature on pediatric PPT. The most common clinical presentations included headache (10 cases), frontal swelling (6 cases) and fever (5 cases). Symptom duration before admission was between 1 and 28 days (median 10 days). The diagnosis of PPT was made by imaging studies at a median of 1 day after admission. All 10 patients underwent computed tomography studies, and 6 patients also underwent magnetic resonance imaging. The overall rate of intracranial complications was 70%. All 10 children were treated with systemic antibiotics and surgical interventions. Streptococcus constellatus group was the most common causal bacteria. All 10 patients recovered uneventfully. Our findings show that a high index of suspicion for PPT should be applied to adolescents presenting with prolonged headache and frontal swelling. Contrast-enhanced computed tomography is an appropriate first tool for the evaluation; however, an magnetic resonance imaging should be performed to determine the necessity of intracranial interventional treatments if there is any suspicion of intracranial involvement. Complete recovery can be expected with appropriate antibiotic treatment and surgical intervention in most of the cases.

Clinical Problem Solving: A 38-year-Old Woman With Systemic Lupus Erythematosus Presenting With Headache, Nausea, and Vomiting.

A 38-year-old woman with migraine headaches and systemic lupus erythematosus with recent cessation of her immunosuppressive therapy presents with prolonged headache and hypertensive emergency. Her examination is notable for a peripheral right facial palsy and stable malar rash. There are no signs of systemic infection nor systemic symptoms of a lupus flare. Initial CT head reveals bilateral hypodensities in the basal ganglia. Within 8hours of presentation, she develops right hemiplegia and becomes encephalopathic. MRI shows multifocal acute infarcts (most notably in the left basal ganglia), enhancement of the right facial nerve, and multifocal vessel wall enhancement in the anterior and posterior circulation. We discuss the differential diagnosis, comprehensive workup, and subsequent treatment decisions in the management of this immunocompromised patient with encephalopathy, headache, and rapidly progressing focal neurologic deficits.

Clinical characteristics and factors associated with headaches following COVID-19 vaccination: a cross-sectional cohort study (P14-12.003)

<h3>Objective:</h3> Describe the coronavirus disease of 2019 (COVID-19) vaccine-related headache characteristics. Determine factors associated with developing headaches and factors related to prolonged headaches (≥ 48h) among COVID-19 vaccine receivers. <h3>Background:</h3> Vaccines are the safest tools for preventing COVID-19-related morbidity/mortality. Headaches are among the most reported neurological symptoms after vaccination. <h3>Design/Methods:</h3> A retrospective, web-based, population-based cross-sectional cohort study between April 2021 – March 2022 at an academic hospital affiliated with Tehran University of Medical Sciences. <h3>Results:</h3> Of 1822 individuals (mean age: 34.49 ± 11.09, female: 71.5%), 1822, 1122, and 203 received 1^st, 2^nd, and 3^rd dose. Sinopharm, AstraZeneca, and Sputnik-V were the most injected vaccines. We found a headache prevalence of 21.7% – 36.5% following vaccination. More than half of those with post-vaccination headaches reported a previous history of headaches, of whom nearly 38% – 67% reported similar post-vaccination headaches to primary headaches. More than 65% of patients reported similarities between their headaches following COVID-19 infection and COVID-19 vaccination. Following vaccination, most of the patients reported bilateral pressing headaches with moderate intensity, affecting the entire head or multiple head/neck regions. The median duration of initiating headaches following vaccination was 8.0 – 10.0 hours, with a median attack duration of 2.0 – 3.0 hours. Headaches lasted for a median of 12.0 – 48.0 hours. Although a history of primary headaches and post-COVID-19 headaches increased the odds of post-vaccination headaches, they reduced the odds of prolonged post-vaccination headaches. Compared to inactivated vaccines, vector ones increased the odds of both occurrence and prolonged post-vaccination headache. Other factors associated with increased odds of post-vaccination headaches were headaches following previous vaccine doses and post-vaccination fever. <h3>Conclusions:</h3> The headache prevalence following vaccination was 21.7% – 36.5%. History of primary headache, post-COVID-19 headache, headaches following previous vaccine doses, vector vaccines, and post-vaccine fever increased the odds of post-vaccination headache. <b>Disclosure:</b> Dr. Jameie has nothing to disclose. Mansoureh Togha has nothing to disclose. Mehdi Azizmohammad Looha has nothing to disclose. Dr. Hemmati has nothing to disclose. Elham Jafari has nothing to disclose. Dr. Nasergivehchi has nothing to disclose. Zeinab Ghorbani has nothing to disclose. Zhale Salami has nothing to disclose.

Paravertebral Cerebrospinal Fluid Exudation in Young Women with Postdural Puncture Headache: A Hypothetical Interpretation based on Anatomical Study on Intervertebral Foramen.

Background Postdural puncture headache (PDPH) is defined as a prolonged orthostatic headache secondary to a lumbar puncture. The mechanism underlying this unpleasant complication and the reasons explaining its higher incidence in the young are not well understood. Here, we speculate on the mechanisms underlying PDPH based on spinal magnetic resonance imaging (MRI) in patients with PDPH and an anatomical study on the size of the intervertebral foramen. Methods Brain and spinal MRI findings were examined in two young women with PDPH. The relationship between age and size of the intervertebral foramen on computed tomography was assessed in 25 female volunteers (22-89 years old) without spinal disease. Results The causative interventions leading to PDPH were epidural anesthesia for painless delivery in a 28-year-old woman and lumbar puncture for examination of the cerebrospinal fluid (CSF) in a 17-year-old woman. These two patients developed severe orthostatic hypotension following the procedure. Brain MRI showed signs of intracranial hypotension, including subdural effusion, in one patient, but no abnormality in the other. Spinal MRI revealed an anterior shift of the spinal cord at the thoracic level and CSF exudation into the paravertebral space at the lumbar level. Treatment involving an epidural blood patch in one patient and strict bed rest with sufficient hydration in the second led to improvement of symptoms and reduction of paravertebral CSF exudation. The size of the intervertebral foramen at the L2-3 level in the 25 volunteers showed a decrease in an age-dependent manner (Spearman's rho -0.8751, p < 0.001). Conclusion We suggest that CSF exudation from the epidural space of the vertebral canal to the paravertebral space through the intervertebral foramen, which is generally larger in the younger population, is the causative mechanism of PDPH.

A clinical observation of recurrent painful ophthalmoplegic neuropathy in a 49-year old female patient

Recurrent painful ophthalmoplegic neuropathy is a rare clinical syndrome, included into the International Classification of Headache Disorders, 3rd edition, and characterized by recurrent headache episodes associated with dysfunction of one or more ocular motor nerves. The diagnosis implies mandatory exclusion of other potential causes of the symptoms. The paper presents a clinical case of a 49-year old female patient with a unilateral headache paroxysms and subsequent paresis of the oculomotor nerve. A thorough clinical assessment, with neuroimaging (brain magnetic resonance imaging and magnetic resonance angiography of arteries and veins of the head) showed no morphological abnormalities that could cause clinical symptoms of oculomotor neuropathy. Her past history was remarkable for a similar episode of prolonged unilateral headache and oculomotor paresis about 10 years before, which were at that time considered as an acute cerebrovascular accident. Thus, two episodes of similar clinical signs of painful neuropathy, the absence of other possible causes of the disease, and the complete regression of symptoms after treatment (ibuprofen and gabapentin) confirmed the diagnosis of recurrent painful ophthalmoplegic neuropathy.

Giant cell arteritis in conditions of coronavirus infection (clinical case)

The complexity of timely diagnosis of giant cell arteritis (GCA), as the most common form of systemic vasculitis in the elderly, is due to the nonspecificity of clinical manifestations and the absence of specific immunological markers. New difficulties arise during the period of coronavirus infection, which manifests itself in similar syndromes and at the same time can provoke immuno-inflammatory rheumatic disease. In this regard, it is extremely important to make a correct differential diagnosis between persistent viral infection and the development of systemic vasculitis. This article presents a clinical observation demonstrating the complex process of diagnosis and differential diagnosis of GCA in the conditions of the COVID-19 pandemic. The patient was hospitalized due to a confirmed coronavirus infection. However, despite the standard therapy and the achieved eradication of the coronavirus, the symptoms characteristic of GCA and polymyalgia rheumatica (PR) persisted. A precision analysis of the clinical picture allowed us to establish that the typical manifestations of GCA and PR occurred in the period preceding COVID-19 infection. Subsequent in-depth examination made it possible to verify the diagnosis of GCA and PR based on the current classification criteria. The therapy with glucocorticoid and methotrexate made it possible to achieve remission. The presented observation will help to raise awareness of general practitioners and related specialties about the need to rule out GCA and PR in the case of prolonged unexplained fever, myalgia, headache, joint pain and swelling, transient visual disturbances, jaw claudication in elderly patients in the setting or after coronavirus infection.

Health-Related Quality of Life in Migraine: EQ-5D-5L-Based Study in Routine Clinical Practice.

Migraine leads to moderate to severe disabilities and disrupts family life, interpersonal relationships, and professional life, and is the second leading cause of disability worldwide. Many people with migraine suffer prolonged headaches and frequent migraine attacks, transition to having chronic migraine, and have the highest number of disability-adjusted life-years. The aim of this study is to measure the quality of life in migraineurs based on the EQ-5D-5L questionnaire. We assessed 100 consecutive patients diagnosed with migraine: 70 with episodic migraine and 30 with chronic migraine. Migraineurs were asked to complete the EQ-5D-5L. The control group (n = 100), matched for sex and age group, was created based on the results of the population norms study for the EQ-5D-5L in the general population of Poland. Patients with migraine had worse HRQoL than the matched general population control group for all three primary endpoints of the EQ-5D-5L questionnaire: dimensions, EQ-5D-5L Index and EQ VAS. Migraine is a disease that disrupts daily function, and as a lifelong disease, plays a role in every aspect of it. Proving a negative impact on many aspects helps to make decisions about treatment, especially in the context of the design and reimbursement of drugs.

Vaccine associated benign headache and cutaneous hemorrhage after ChAdOx1 nCoV-19 vaccine: A cohort study

ObjectivesFatal complications have occurred after vaccination with ChAdOx1 nCoV-19, a vaccine against Covid-19. Vaccine-induced immune thrombotic thrombocytopenia (VITT) with severe outcome is characterized by venous thrombosis, predominantly in cerebral veins, thrombocytopenia and anti-PF4/polyanion antibodies. Prolonged headaches and cutaneous hemorrhages, frequently observed after the ChAdOx1 nCoV-19 vaccine, have therefore caused anxiety among vaccinees. We investigated whether these symptoms represent a mild form of VITT, with a potential for aggravation, e.g. in case of a second vaccination dose, or a different entity of vaccine complications Materials and methodsWe included previously healthy individuals who had a combination of headache and spontaneous severe cutaneous hemorrhages emerging after the 1st dose of the ChAdOx1 nCoV-19 vaccine. Twelve individuals were found to meet the inclusion criteria, and a phone interview, cerebral MRI, assessment of platelet counts, anti PF4/polyanion antibodies and other laboratory tests were performed. ResultsNone of the symptomatic vaccinees had cerebral vein thrombosis, hemorrhage or other pathology on MRI. Platelet counts were within normal range and no anti-PF4/polyanion platelet activating antibodies were found. Moreover, vasculitis markers, platelet activation markers and thrombin generation were normal. Furthermore, almost all symptoms resolved, and none had recurrence of symptoms after further vaccination with mRNA vaccines against Covid-19. ConclusionsThe combination of headaches and subcutaneous hemorrhage did not represent VITT and no other specific coagulation disorder or intracranial pathology was found. However, symptoms initially mimicking VITT demand vigilance and low threshold for a clinical evaluation combined with platelet counts and D–dimer.

Recurrent macrophage activation syndrome due to hyperimmunoglobulin D syndrome: a case-based review.

Hyperimmunoglobulin D syndrome (HIDS) is a hereditary autoinflammatory disease characterized by recurrent inflammatory attacks with fever, abdominal pain, lymphadenopathy, aphthous stomatitis, and skin lesions. There are few reports on HIDS patients complicated with macrophage activation syndrome (MAS); however, to our knowledge, there is no case of HIDS with recurrent MAS attacks. We report two pediatric patients initially diagnosed as Kawasaki disease and systemic juvenile idiopathic arthritis presented with recurrent MAS episodes with prolonged fever, skin rash, hepatosplenomegaly, cervical lymphadenopathy, aphthous stomatitis, headache, pancytopenia, hyperferritinemia, and hypofibrinogenemia, finally diagnosed as HIDS with a documented homozygous MVK gene mutation. This is the first report on recurrent MAS attacks due to HIDS in pediatric patients who were successful treated with corticosteroids and anti-IL-1 therapies. Thus, clinicians should be vigilantly investigated signs of autoinflammatory diseases in patients with recurrent MAS attacks during their disease course, and HIDS should be considered an underlying disease for triggering recurrent MAS attacks. We have also reviewed the current literature regarding HIDS cases complicated with a MAS attack and summarized their demographic, treatment, and outcome characteristics. Key points • Hyperimmunoglobulin D syndrome should be considered in differential diagnosis in patients who experienced recurrent macrophage activation syndrome attacks.

Real World studies on undesirable effects of some Anti-Thrombotic Drugs in a tertiary Hospital

Introduction: Antithrombotic drugs include antiplatelet, anticoagulant and fibrinolytics. Antithrombotic drugs either block the formation of new clots, or prevent the growth of existing clots or reduce risk of complications from blood clots. These drugs are used in various Cardio and neurological diseases ranging from Angina, stroke to as Dual Antiplatelet Therapy (DAT) in post implantation of permanent medical devices. Antithrombotic drugs have numerous side effects from gastritis, prolonged bleeding, hemorrhage, tachycardia, tinnitus based on the class of drugs.&#x0D; Study design and Objective: Though the undesirable effects of antithrombotic drugs are well established in controlled trails, there were rare studies in Real world population. Hence a prospective observational study was under taken to understand the undesirable effects in a Tertiary hospital in India and analyze the pattern based on age, gender, intended and indications of use and dosage regimen. The undesirable effects of Aspirin, Heparin and Clopidogrel were studied in 92 patients over a period of 6 months.&#x0D; Results and Discussion: In the current study there were 8 cases were heparin was indicated and 50% of the patients complained of haemorrhage / bleeding and in 2 cases there is heavy bleeding during cut wounds. All this cases were found in patients where Heparin is used in Cardiology and neurological diseases and old age group on different indications of use. In 60 patients who are on Aspirin therapy 43 patients are in cardiology and 17 in neurological treatment. Most of the indications are for CAD, Myocardial Infraction (MI) and Angina. Important undesirable effects noted in the present study include SOB-9 patients, Tachycardia- 5, Blood in stools-4 patients, Tinnitus -3 patients and Ulcers in 3 patients. Of the 92 cases, Clopidogrel was prescribed for different indications of use in 24 patients. Of them 19 patients are in cardiology and 5 patients are in neurology treatment. Most commonly patients were diagnosed with MI, unstable angina and CVA Ischemic stroke, with observed undesirable effects like prolonged bleeding, dyspepsia, headache, indigestion, heart burn and tachycardia. The study clearly shows that prolonged bleeding was observed in 40% of the patients on clopidogrel mainly in segment with higher doses and on co-medication&#x0D; Conclusion: The present study has shown similar undesirable effects evidenced in controlled clinical trials. However, the study indicates Intravenous administration of Heparin is advised than subcutaneous route and need for larger studies to substantiate the same. It is also recommended that patients on Aspirin should be recommended for low dose mainly in indications related to cardiovascular diseases than higher dosed. Most of the adverse effects are found in patients taking more than 75 mg and BID and TID. It could be related to dose induced effects and also the includes the age factor as most of them are geriatrics and not on anti-ulcer drugs. The study clearly shows that prolonged bleeding was observed in 40% of the patients on clopidogrel mainly in segment with higher doses and on co-medication. A case was reported on overdose of Clopidogrel which resulted in abnormalities in platelet aggregation that required emergency medical care.