Awareness of triggers of headache in migraine patients – a study from a tertiary centre from central india

Background:A lot of discrepancies in the number of migraine triggers have been observed in numerous studies. Migraine patients do not recognize easily their headache triggers in clinical practice. Focusing the patient attention on migraine attack triggers is important for management of migraine. Awareness of migraine triggers has not been previously studied in India. Therefore, we planned to study the awareness of triggers of headache among migraine patients from central India.Materials and methods:We recruited 180 migraine patients to evaluate the awareness about their headache triggers. Patients were asked to perform two tasks. Task 1 was to report their migraine trigger spontaneously in 2 minutes. Subsequently, Task 2 was to identify common/uncommon known triggers from given lists. Awareness of triggers among population was estimated by difference of distribution of self reported versus identified common/uncommon triggers.Results:The average number of self reported triggers among all patients was found to be 2.21±1.80. Noise (74.4%), Sunlight (70.6%), Smoking (70.0%), Fasting (67.2%) were the most prevalent trigger factors. Difference of distribution between Task 1 and Task 2 was calculated, which showed (200% difference in self reported versus common triggers) and (83.3% difference in self reported versus uncommon triggers).Conclusion:Migraine patients have poor awareness of their headache triggers and hardly reports triggers unless asked specifically. Keywords: headache, migraine, triggers, migraine with aura, migraine without aura, awareness of triggers of migraine

Post epidural puncture delirium resulting from pneumocephalus: An uncommon presenation

A 50-year-old female came with a history of chronic lower back pain radiating to right leg for which she received an epidural steroid injection. Two hours later, she was found to in a delirious state with bilateral ptosis. Magnetic resonance imaging of the brain was suggestive of ventricular pneumocephalus in frontal and temporal horns of right lateral ventricles. She was managed conservatively with oxygen inhalation. Patient’s sensorium improved after 72 h

Determinants of remission in medically treated carpal tunnel syndrome: Study from Central India

Background: The factors associated with the spontaneous remission (SR) of symptoms in carpal tunnel syndrome (CTS) are not well known. Objectives: To look for determinants of SR in medically treated, electrophysiologically proven patients of CTS. Methods: We revisited the medical records and nerve conduction study data of 130 hands with CTS and divided them into two groups as per the absence or persistence of the symptoms when contacted after a median time lapse of 3 years following the diagnosis. Results: SR occurred in 46.1% of the hands. Higher odds of SR were linked with female gender, symptoms restriction to lateral fingers, symptom duration 20 μV. We developed a seven-point scale, on which a score of ≥4 had a strong association (odds ratio 4.31) with SR. Discussion and Conclusion: No single risk factor, standalone, can predict SR in patients with CTS, which could lead to an invasive treatment (Surgery or local injection) to them. We propose that patients scoring ≥4 on our 7 point scale should be treated medically for the initial 10 months after the symptom onset