Хроническая мигрень, ассоциированная с сахарным диабетом I типа

Catedra Neurologie, USMF „Nicolae Testemiţanu”, Institutul de Neurologie şi NeurochirurgieMigraine is estimated to be found in about 30% of patients with diabetes mellitus (DM) type I. The migraine associated with DM is a complex scientific and clinical problem. The article is a case presentation of a patient with chronic migraine (ChM) associated with DM type I having clinical manifestations which included daily medium to strong headaches located unilaterally or bilaterally with a compressive or pulsating pattern lasting more than 4 hours, sometimes associated with nausea, vomiting, photophobia, phonophobia or osmophobia. Headache attacks were aggravated by physical effort or stress. The patient has a genetic predisposition to migraine (her mother and brother suffered from ChM for many years). The patient underwent a complex examination: EEG, fundoscopy, angio-CT and MRI of the brain, ECG, ultrasound of the abdominal organs, and a radioscopy of the stomach. The psychometric evaluation utilized the Spielberger and Beck questionnaire. The test revealed a moderate level of anxiety and depression, as well as the patient’s histrionic personality. Effective treatment of metabolical changes in DM contributed to the reduction of the intensity and frequency of migraine attacks.Частота распространенности мигрени высока среди пациентов, которые давно страдают сахарным диабетом (СД) I типа, в среднем около 30%. Сопутствующая сахарному диабету мигрень представляет собой сложную и интересную в научном плане задачу. Представлен клинический случай пациентки с хронической мигренью (ХМ) в сочетании с СД I типа. В клинической картине были ежедневные приступы головной боли, средней и сильной интенсивности, одно- или двухсторонние, сжимающего или пульсирующего характера, длительностью более 4-х часов, сочетающиеся с тошнотой, иногда рвотой, фото-, фоно- и осмофобией. Приступы усиливались при физической нагрузке или при психоэмоциональных стрессах. У пациентки присутствовала генетическая предрасположенность к мигрени (мать и брат страдают хронической мигренью в течение многих лет). Больная была многосторонне обследована: ЭЭГ, офтальмоскопия, ангио-КТ, МРТ головного мозга, ЭКГ, УЗИ органов брюшной полости, Rg-скопия желудка и т.д. Психометрические тесты (Спилберг, Бек, DSM-IV опросник), выявили высокий уровень реактивной и личностной тревоги, депрессию средней степени выраженности, а также черты хистрионической личности. Эффективное лечение расстройств способствовало уменьшению интенсивности и частоты сопутствующих мигренозных атак

Diagnostic and therapeutic errors in cluster headache: a hospital-based study.

Cluster headache (CH) is a severe, disabling form of headache. Even though CH has a typical clinical picture it seems that its diagnosis is often missed or delayed in clinical practice. CH patients may thus face: misdiagnosis, unnecessary investigations and delays in accessing adequate treatment. This study was conducted to investigate the occurrence of diagnostic and therapeutic errors with a view to improving the clinical and instrumental work-up in affected patients. METHODS: Our study comprised 144 episodic CH patients: 116 from Italy and 28 from Eastern European countries (Moldova, Ukraine, Bulgaria). One hundred six patients (73.6%) were examined personally and 38 (26.4%) were evaluated through telephone interviews conducted by headache specialists using an ad hoc questionnaire developed by the authors. RESULTS: The sample was predominantly male (M:F ratio 2.79:1) and had a mean age of 42.4 ± 9.8 years; approximately 76% of the patients had already consulted a physician about their CH at the onset of the disease. The mean interval between onset of the disease and first consultation at a headache center was 4.1 ± 5.6 years. The patients had consulted different specialists prior to receiving their CH diagnosis: neurologists (49%), primary care physicians (35%), ENT specialists (10%), dentists (3%), etc. Misdiagnoses at first consultation were recorded in 77% of the cases: trigeminal neuralgia (22%), migraine without aura (19%), sinusitis (15%), etc. The average "diagnostic delay" was 5.3 ± 6.4 years and the condition was diagnosed approximately ("doctor delay": one year). Instrumental and laboratory investigations were carried out in 93% of the patients prior to diagnosis of CH. Some of the patients had never received abortive or preventive medications, either before or after diagnosis. Medical prescription compliance: 88% of the cases. CONCLUSIONS: Our results emphasize the need to improve specialist education in this field in order to improve recognition of the clinical picture of CH and increase knowledge of the proper medical treatments for de novo CH. Continuous medical education on CH should target general neurologists, primary care physicians, ENT specialists and dentists. A study on a larger population of CH patients may further improve error-avoidance strategies

Frontal thermography in healthy individuals and headache patients: reliability of the method

Frontal thermography in headcah

The evolution of headache from childhood to adulthood: a review of the literature.

Headache is one of the most common disorders in childhood, with an estimated 75% of children reporting significant headache by the age of 15 years. Pediatric migraine is the most frequent recurrent headache disorder, occurring in up to 28% of older teenagers. Headaches rank third among the illness-related causes of school absenteeism and result in substantial psychosocial impairment among pediatric patients. The aim of this study was to clarify the evolution of the clinical features of primary headache in the transition from childhood to adulthood through a review of relevant data available in the PubMed and Google Scholar databases for the period 1988 to July 2013.The search strategy identified 15 published articles which were considered eligible for inclusion in the analysis (i.e., relevant to the investigation of pediatric headache outcome). All were carried out after the publication of the first version of the International Classification of Headache Disorders (ICHD-I). The availability of data on the evolution of primary headaches over a period of time is important from both a clinical and a public health perspective. The identification of prognostic factors of the evolution of headache (remission or evolution into another headache form) over time should be an objective of future headache research for the development of prevention strategies. Given that headache is a major factor contributing to school absenteeism and poorer quality of life not only in childhood but also in adolescence, understanding the natural history and the management of the different headache forms is vital for our future

Frontal thermography in healthy individuals and headache patients: reliability of the method.

Studio di accuratezza e riproducibilità della termografia frontale nell cefalee primari