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1.
Background
State-related brain structural alterations in patients with episodic tension-type headache (ETTH) are unclear. We aimed to conduct a longitudinal study to explore dynamic gray matter (GM) changes between the pain and pain-free phases in ETTH.Methods
We recruited 40 treatment-naïve ETTH patients and 40 healthy controls. All participants underwent brain structural scans on a 3.0-T MRI system. ETTH patients were scanned in and out of pain phases. Voxel-based morphometry analysis was used to determine the differences in regional gray matter density (GMD) between groups. Additional regression analysis was used to identify any associations between regional GMD and clinical symptoms.Results
ETTH patients exhibited reduced GMD in the bilateral primary somatosensory cortex, and increased GMD in the bilateral anterior cingulate cortex (ACC) and anterior insula for the in pain phase compared with the out of pain phase. The out of pain phase of ETTH patients exhibited no regions with higher or lower GMD compared with healthy controls. GMD in the left ACC and left anterior insula was negatively correlated with headache days. GMD in the left ACC was negatively correlated with anxiety and depressive symptoms in ETTH patients.Conclusions
This is the first study to demonstrate dynamic and reversible GMD changes between the pain and pain-free phases in ETTH patients. However, this balance might be disrupted by increased headache days and progressive anxiety and depressive symptoms.2.
Background
Subcutaneous peripheral nerve field stimulation (sPNFS) is an established procedure for the treatment of chronic localized neuropathic pain of peripheral origin. The treatment of nummular headache primarily focuses on conservative methods with limited prospects of success. The role of sPNFS in the treatment of nummular headache has not been investigated as yet.Question
Is the sPNFS an option in the management of nummular headache?Materials and methods
In addition to a summary of established methods in the treatment of nummular headache, sPNFS as a possible form of therapy is discussed.Results
A positive effect of sPNFS in terms of the treatment of nummular headache is shown.Discussion
sPNFS stimulates free subcutaneous nerves and transmits a pleasant form of paraesthesia in the area of pain. If regular conservative therapy has already been exhausted, then sPNFS might be an effective new option in the treatment of nummular headache. sPNFS is a minimally invasive and low-risk procedure. However, the high treatment cost and restrictions regarding fitness to undergo MRI are points of criticism. Further studies are needed to define its potential and role in the treatment of nummular headache.3.
4.
Background
Until now, headache disorders have not been established as a risk factor for dementia. The aim of this study was to determine whether headache was associated with an increased risk of dementia.Methods
We systematically searched electronic databases, including PubMed, Embase, and Web of Science, for studies investigating the association between headache and dementia. We then conducted a meta-analysis to determine a pooled-effect estimate of the association.Results
We identified 6 studies (covering 291,549 individuals) to investigate the association between headache and the risk of all-cause dementia or Alzheimer’s disease (AD). Pooled analyses showed that any headache was associated with a 24% greater risk of all-cause dementia (relative risk [RR]?=?1.24; 95% confidential interval [CI]: 1.09–1.41; P?=?0.001), and that any headache was not statistically significantly associated with an increased risk of AD (RR?=?1.47; 95% CI: 0.82–2.63; P?=?0.192).Conclusions
Our results indicated that any headache was associated with an increased risk of all-cause dementia. However, additional studies are warranted to further confirm and understand the association.5.
Purpose of Review
The purpose of this review is to summarize the most up-to-date literature on bath-related headache, a rare disorder.Recent Findings
Initially described in middle-aged Asian women, it is now reported in a wider demographic. More information is available about the pathophysiology of bath-related headache, including its classification as a subtype of reversible cerebral vasoconstriction syndrome (RCVS). Nimodipine can be effective in patients both with and without vasospasm.Summary
Bath-related headache is a rare form of thunderclap headache. Although its mechanism is still unclear, it is associated with vasospasm and RCVS. Controlled trials investigating the use of nimodipine and other agents may be useful in furthering our understanding of and treatment of this phenomenon.6.
S. Dreßke 《Schmerz (Berlin, Germany)》2016,30(4):333-338
Background
Every professional segment has its own typical forms of stress, which for members result in patterns of bodily conception and interpretation of pain. The way individuals cope with these typical forms of pain reflects their social identity, social status and group membership. In this study pain was investigated from a sociological perspective as a medium contributing to socialization processes in stress collectives.Objectives
Cultural conceptions of headache and migraine were investigated in members of blue collar occupations, in service professions and patients in specialized medical pain care.Materials and methods
In this study 49 qualitative biographical interviews were conducted with patients suffering from headache and migraine. The study population included persons from the general outpatient population and patients recruited from specialized inpatient pain clinics.Results
Members of blue collar occupations with specific body-oriented, mechanical stress patterns and dominant masculine attitudes, perceived headache and migraine as atypical deviations, which are contextualized as body pain. Professionals in the service sector with specific communicative-emotional work patterns perceived headache and migraine as typical and accepted deviations. Both pain conceptions represent dominant body norms and social commitments in each group; however, in specialized pain care these everyday concepts are transformed by increasing expert knowledge resulting in medicalized life styles and in identity conceptions conforming to the medical imperative.Conclusion
The success of specialized treatment of headache depends to a certain extent on the ability of patients to impose a medically regulated life style on their significant others; however, this can conflict with the demands of everyday life.7.
Objective
To compare the safety and estimate the response profile of olanzapine, a second-generation antipsychotic, to haloperidol in the treatment of delirium in the critical care setting.Design
Prospective randomized trialSetting
Tertiary care university affiliated critical care unit.Patients
All admissions to a medical and surgical intensive care unit with a diagnosis of delirium.Interventions
Patients were randomized to receive either enteral olanzapine or haloperidol.Measurements
Patient’s delirium severity and benzodiazepine use were monitored over 5 days after the diagnosis of delirium.Main results
Delirium Index decreased over time in both groups, as did the administered dose of benzodiazepines. Clinical improvement was similar in both treatment arms. No side effects were noted in the olanzapine group, whereas the use of haloperidol was associated with extrapyramidal side effects.Conclusions
Olanzapine is a safe alternative to haloperidol in delirious critical care patients, and may be of particular interest in patients in whom haloperidol is contraindicated.8.
Introduction
Chronic tension headache is a common medical problem. Many patients present to manual medicine specialists. Scientific data regarding the relevance of somatic dysfunction for the pathogenesis of chronic tension headache are inconsistent. In order to address this issue, a study protocol was developed. In the present study, the first two steps of the protocol were undertaken.Material and methods
In order to identify valuable functional findings and tests, the first step of the study was a Delphi process. The second step consisted of testing the inter-rater reliability of the suggested tests.Results
In total, 38 different clinical tests were identified to be relevant for chronic tension headache. Inter-rater reliability was reasonable for somatic dysfunction of the cervical spine, as was the test for muscular tension of the trapezius muscle. None of the other tests were found to be sufficiently reliable.Conclusion
We could show that a subset of tests assumed to be relevant for chronic tension headache are reliable. The other tests have to be refined or the study protocol has to adapted to obtain an even distribution of positive/negative findings.9.
Purpose of Review
This review evaluates and explains our current understanding of a rare subtype of migraine, typical aura without headache, also known as migraine aura without headache or acephalgic migraine.Recent Findings
Typical aura without headache is a known entity within the spectrum of migraine. Its pathophysiology is suggested to be similar to classic migraines, with cortical spreading depression leading to aura formation but without an associated headache. No clinical trials have been performed to evaluate treatment options, but case reports suggest that most patients will respond to the traditional treatments for migraine with aura. Bilateral greater occipital nerve blocks may be helpful in aborting migraine with prolonged aura. Transcranial magnetic stimulation has shown efficacy in aborting attacks of migraine with aura but has not been specifically tested in isolated aura.Summary
Typical aura without headache occurs exclusively in 4% patients with migraine, and may take place at some point in 38% of patients with migraine with aura. Typical aura without headache commonly presents with visual aura without headache, brainstem aura without headache, and can also develop later in life, known as late-onset migraine accompaniment.10.
Background
Orbital cellulitis is a relatively uncommon presentation in the emergency department, but orbital cellulitis complicated by intracranial extensions, loss of vision, and death has rarely been reported in the literature.Case presentation
We report a 40-year-old Pakistani diabetic male complaining of 5 days of bilateral eye pain, proptosis, ophthalmoplegia, headache, and fever. A diagnosis of orbital cellulitis with intracranial extension was made. A computed tomography (CT) scan and a magnetic resonance imaging (MRI) were done on the patient and showed unremarkable orbits, extensive sinusitis, frontal abscess, and multiple septic emboli. The patient was admitted and on day 9 deteriorated and died.Conclusion
Orbital cellulitis associated with intracranial extension is an extremely rare presentation, and the incidence is unknown. The use of contrast-enhanced imaging studies (CT/MRI) early on in the management of suspected orbital cellulitis is supported by the literature. Cerebritis and brain abscesses resulting from orbital cellulitis need advanced care from multidisciplinary teams. Further studies need to be done to provide recommendations on the use and benefit of surgical intervention.11.
Rachel E. Davis-Martin Ashley N. Polk Todd A. Smitherman 《Current pain and headache reports》2017,21(10):42
Purpose of Review
In contrast to well-established relationships between headache and affective disorders, the role of alcohol use in primary headache disorders is less clear. This paper provides a narrative overview of research on alcohol use disorders (AUDs) in primary headache and presents a meta-analysis of the role of alcohol as a trigger (precipitant) of headache.Recent Findings
The majority of studies on AUDs in headache have failed to find evidence that migraine or tension-type headache (TTH) is associated with increased risk for AUDs or problematic alcohol use. The meta-analysis indicated that 22% (95% CI: 17–29%) of individuals with primary headache endorsed alcohol as a trigger. No differences were found between individuals with migraine (with or without aura) or TTH. Odds of endorsing red wine as a trigger were over 3 times greater than odds of endorsing beer.Summary
An absence of increased risk for AUDs among those with primary headache may be attributable to alcohol’s role in precipitating headache attacks for some susceptible individuals. Roughly one fifth of headache sufferers believe alcohol precipitates at least some of their attacks. Considerable study heterogeneity limits fine-grained comparisons across studies and suggests needs for more standardized methods for studying alcohol-headache relationships and rigorous experimental designs.12.
Johna K. Register-Mihalik Christina B. Vander Vegt Michael Cools Kevin Carnerio 《Current pain and headache reports》2018,22(11):75
Purpose of Review
The purpose of this review is to (1) describe factors both pre- and post-injury that are associated with post-concussion headache, (2) describe the influence of post-concussion headache on recovery following concussion, and (3) provide potential post-concussion treatment options that may reduce the burden of headache, as well as other symptoms to facilitate recovery.Recent Findings
Various factors may be associated with post-concussion headache presentation. These may include pre-injury or historical factors such as sex, family and self-history of headache and migraine, concussion history, and mood disorders. In addition, post-injury presentation factors for consideration may include injury mechanism, symptom clusters, cervicogenic dysfunction, and post-concussion physiologic dysfunction. Despite this complex interplay of factors, many treatment options may improve headache symptoms and recovery post-concussion including rehabilitation programs focusing on deficits such as visual-vestibular dysfunction, sub-symptom threshold exercise, and potential pharmacological interventions.Summary
Concussion is a complex injury that results in a variety of sequelae with headache being one of the most common. Understanding factors related to post-concussion headache presentation and the available options for treatment may improve patient care and outcomes post-concussion.13.
Purpose of Review
Pituitary tumors account for approximately 17% of all intracranial neoplasms, with the majority being pituitary adenomas. Often, these are found incidentally during a workup for headache; however, the relationship between symptom and pathology remains unclear. The purpose of this article is to review the most recent literature on the epidemiology, pathophysiology, and management of headaches in patients with pituitary tumors.Recent Findings
The current literature is limited, with few prospective trials focusing on this question. With the exception of pituitary apoplexy, the relationship between headaches and pituitary masses remains unclear. Intervention does not always improve headache and can lead to development of new headache syndromes.Summary
Further research is needed to better elucidate the relationship between pituitary tumors and headaches. Headache alone is rarely an indication for surgical management of a pituitary adenoma.14.
15.
Purpose of Review
In this short review, the most common non-invasive neuromodulatory techniques will be described, along with their advantages and disadvantages and their application in headache. Available preventive treatments can be unhelpful or may have unpleasant side effects; moreover, the rate of response to preventive drugs does not exceed 50%, lower in chronic migraine; alternative options would be welcome. Though the concept of neuromodulation was originally developed with invasive methods, newer non-invasive techniques are appearing.Recent Findings
The novel neuromodulatory techniques have been developed with encouraging results: compared with traditional pharmacotherapy, advantages of non-invasive neuromodulation include reduced incidence of adverse effects, improved adherence, and safety and ease of use. The results are encouraging for acute or preventive treatment of different kinds of headache.Summary
A variety of neuromodulatory approaches is expanding fastly and has opened new possibilities for treatment of patients suffering from many forms of headache, especially those who have failed traditional pharmacotherapy. The non-invasive treatments can be seen as supplementing traditional management in refractory patients. Current study results are encouraging but preliminary and larger and more rigorous trials are needed to clarify benefit and mode of action.16.
Background
Acupuncture is a form of traditional Chinese medicine being increasingly used as complementary therapy in many countries. It is relatively safe and rarely associated with deep infections.Case presentation
In this case report, we describe a middle-aged Chinese patient who presented acutely to our emergency department with cauda equina syndrome secondary to acupuncture-related epidural abscesses, which were treated with surgical decompression and intravenous antibiotics. We also present a review of case reports of this rare condition in available literature.Conclusion
Emergency physicians should be aware that spinal abscesses may occur after acupuncture, with a broad spectrum of clinical presentations. If a history of recent acupuncture over the symptomatic area is elicited, a high index of suspicion should be maintained and appropriate imaging performed to establish the diagnosis. Treatment is directed by a number of factors, such as severity and duration of neurological deficit and progression of symptoms.17.
Anna Theodorou-Kanakari Spyridon Karampitianis Vasiliki Karageorgou Eleni Kampourelli Efstathios Kapasakis Panagiotis Theodossiadis Irini Chatziralli 《Advances in therapy》2018,35(10):1510-1518
Introduction
The purpose of this review is to present the current and emerging treatment alternatives for Leber’s hereditary optic neuropathy (LHON), emphasizing the most recent use of idebenone and stem cells or gene therapy.Methods
A comprehensive literature review was performed at the PubMed database regarding the various treatment modalities for LHON.Results
Treatment modalities for LHON include nutritional supplements, activators of mitochondrial biogenesis, brimonidine, and symptomatic and supportive treatment, but nowadays attention is being paid to idebenone and gene therapy or stem cells.Conclusion
The treatment of LHON remains challenging, given the nature of the disease and its prognosis.18.
Maneesh Gupta 《Clin Pract Epidemiol Ment Health》2007,3(1):12
Background
Quetiapine causes less prolactin elevation and/or galactorrhoea than other atypical antipsychotics.Case Presentation
Ms AB had galactorrhoea and raised prolactin levels at only 100 mg of quetiapine daily.Conclusion
Low dose quetiapine can also cause galactorrhoea.19.
Alexandros Karargyris Jenifer Siegelman Dimitris Tzortzis Stefan Jaeger Sema Candemir Zhiyun Xue K. C. Santosh Szilárd Vajda Sameer Antani Les Folio George R. Thoma 《International journal of computer assisted radiology and surgery》2016,11(1):99-106
Purpose
To improve detection of pulmonary and pleural abnormalities caused by pneumonia or tuberculosis (TB) in digital chest X-rays (CXRs).Methods
A method was developed and tested by combining shape and texture features to classify CXRs into two categories: TB and non-TB cases. Based on observation that radiologist interpretation is typically comparative: between left and right lung fields, the algorithm uses shape features to describe the overall geometrical characteristics of the lung fields and texture features to represent image characteristics inside them.Results
Our algorithm was evaluated on two different datasets containing tuberculosis and pneumonia cases.Conclusions
Using our proposed algorithm, we were able to increase the overall performance, measured as area under the (ROC) curve (AUC) by 2.4 % over our previous work.20.