Sleep Patterns Changes Depending on Headache Subtype and Covariates of Primary Headache Disorders

Headache is one of the most common and bothersome problems in neurology practice. The frequency of headache has been substantially increased over the last 30 years due to changes in lifestyle. Controlling the trigger factors and lifestyle changes (e.g. regular sleep, meal time, exercise, etc.) are the first step management strategies in headaches. Sleep and headache have bidirectional effects on each other. While diminished and poor quality of sleep can be a trigger factor for headache (e.g. migraine and tension-type headache (TTH)), some types of headache like hypnic headache and cluster-type headache mainly occur during sleep. Patients with headache may have poor sleep quality, reduced total sleep time, more awakenings, and alterations in architecture of sleep recorded by polysomnography. Progression to chronic forms of headache may also be associated with the duration and quality of sleep. Even though pathophysiology of headache and sleep disorders shares the same brain structures and pathways, sleep disturbances are commonly underestimated and underdiagnosed in headache patients. Clinicians should consider and behold the treatment of accompanying sleep complaints for an effective management of headache

European Headache Federation (EHF) consensus on the definition of effective treatment of a migraine attack and of triptan failure

Attack; Migraine; TriptanAtaque; Migraña; TriptánAtac; Migranya; TriptanBackground Triptans are migraine-specific acute treatments. A well-accepted definition of triptan failure is needed in clinical practice and for research. The primary aim of the present Consensus was to provide a definition of triptan failure. To develop this definition, we deemed necessary to develop as first a consensus definition of effective treatment of an acute migraine attack and of triptan-responder. Main body The Consensus process included a preliminary literature review, a Delphi round and a subsequent open discussion. According to the Consensus Panel, effective treatment of a migraine attack is to be defined on patient well-being featured by a) improvement of headache, b) relief of non-pain symptoms and c) absence of adverse events. An attack is considered effectively treated if patient’s well-being, as defined above, is restored within 2 hours and for at least 24 hours. An individual with migraine is considered as triptan-responder when the given triptan leads to effective acute attack treatment in at least three out of four migraine attacks. On the other hand, an individual with migraine is considered triptan non-responder in the presence of failure of a single triptan (not matching the definition of triptan-responder). The Consensus Panel defined an individual with migraine as triptan-resistant in the presence of failure of at least 2 triptans; triptan refractory, in the presence of failure to at least 3 triptans, including subcutaneous formulation; triptan ineligibile in the presence of an acknowledged contraindication to triptan use, as specified in the summary of product characteristics. Conclusions The novel definitions can be useful in clinical practice for the assessment of acute attack treatments patients with migraine. They may be helpful in identifying people not responding to triptans and in need for novel acute migraine treatments. The definitions will also be of help in standardizing research on migraine acute care.This work is supported by a grant from the European Headache Federation to cover publication fees

Use of non-pharmacological therapies in individuals with migraine eligible for treatment with monoclonal antibodies targeting Calcitonin Gene-Related Peptide (CGRP)-signaling: a single-center cross-sectional observational study

Introduction: Accessibility of treatment with monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) signaling pathway is impeded by regulatory restrictions. Affected individuals may seek out other services including non-pharmacological therapies. Thus, we found it timely to ascertain the use of non-pharmacological therapies in individuals with treatment-resistant migraine eligible for and naïve to treatment with CGRP-signaling targeting monoclonal antibodies. Methods: We conducted a single-center cross-sectional observational study of patients eligible for and naïve to treatment with monoclonal antibodies targeting CGRP or its receptor. We recorded demographical information (gender, age, educational level, employment status, and income), disease burden (frequency of headache days and migraine days), previous use of preventive pharmacological medications for migraine, and use of non-pharmacological therapies over the past 3 months including frequency of interventions, costs, and patient-reported assessment of efficacy on a 6-point scale (0: no efficacy, 5: best possible efficacy). Results: We included 122 patients between 17 June 2019 and 6 January 2020; 101 (83%) were women and the mean age was 45.2 ± 13.3 years. One-third (n = 41 [34%]) had used non-pharmacological therapy within the past 3 months. Among these participants, the median frequency of different interventions was 1 (IQR: 1–2), the median number of monthly visits was 2.3 (IQR: 1.3–4), mean and median monthly costs were 1,086 ± 1471, and 600 (IQR: 0–1200) DKK (1 EUR = ~7.5 DKK), respectively, and median patient-reported assessment of the efficacy of interventions was 2 (IQR: 0–3). Conclusion: Even in a high-income country with freely accessible headache services and universal healthcare coverage, there was a non-negligible direct cost in parallel with low satisfaction for non-pharmacological therapies among patients at a tertiary headache center.info:eu-repo/semantics/publishedVersio

Undifferentiated headache: broadening the approach to headache in children and adolescents, with supporting evidence from a nationwide school-based cross-sectional survey in Turkey

Background: Headache is a leading disabler in adults worldwide. In children and adolescents, the same may be true but the evidence is much poorer. It is notable that published epidemiological studies of these age groups have largely ignored headaches not fulfilling any specific set of ICHD criteria, although such headaches appear to be common. A new approach to these is needed: here we introduce, and investigate, a diagnostic category termed undifferentiated headache (UdH), defined in young people as recurrent mild-intensity headache of <1 h's duration. Methods: We conducted a nationwide cross-sectional survey in 31 schools in six regions of Turkey selected by mixed convenience-based and purposive modified cluster-sampling. A validated, standardised self-completed structured questionnaire was administered by a physician-investigator to entire classes of pupils aged 6-17 years. Results: Of the identified sample of 7889 pupils, 7088 (89.8%) participated. The 1-year prevalence of UdH was 29.2%, of migraine (definite and probable) 26.7%, and of tension-type headache (TTH) (definite and probable) 12.9%. UdH differed with respect to almost all headache features and associated symptoms from both migraine and TTH. Burden of headache and use of acute medication were lower in UdH than in migraine and TTH. Headache yesterday was less common in UdH than migraine (OR 0.32; 95% CI 0.28-0.37) and TTH (OR 0.64; 95% CI 0.56-0.77). Quality of life (QoL) was better in UdH (33.6 +/- 5.2) than in migraine (30.3 +/- 5.6; p < 0.001) and TTH (32.4 +/- 5.3; p < 0.001), but worse than in pupils without headache (35.7 +/- 4.7; p < 0.001). Conclusions: This large nationwide study in Turkey of pupils aged 6-17 years has shown that many children and adolescents have a headache type that does not conform to existing accepted diagnostic criteria. This new diagnostic category of presumably still-evolving headache (undifferentiated headache) is common. UdH differs in almost all measurable respects from both migraine and TTH. Although characterised by mild headaches lasting < 1 h, UdH is associated with significant adverse impact on QoL. Longitudinal cohort studies are needed to evaluate the prognosis of UdH but, meanwhile, recognition of UdH and its distinction from migraine and TTH has implications for epidemiological studies, public-health policy and routine clinical practice

Real-life experiences with galcanezumab and predictors for treatment response in Turkey

BackgroundThe complexity of clinical practice extends far beyond the controlled settings of trials, and there is a need for real-world studies aimed at identifying which patients will respond to anti-CGRP monoclonal antibodies in different countries. This study aimed to investigate the efficacy and safety of galcanezumab in treating migraine in a real-life setting in Turkey, as well as identify predictors of treatment response.MethodsA total of 476 patients who diagnosed with migraine according to ICHD-3 criteria and treated with galcanezumab by headache specialists were voluntarily participated in this cross-sectional study. Galcanezumab is indicated for the prevention of migraine in adults who have at least 4 monthly migraine days in Turkey. All patients filled out a survey on Google Form that comprised 54 questions, addressing various aspects such as demographics, migraine characteristics, previous use of acute symptomatic medication, failures with preventive drug classes, comorbidities, most bothersome symptoms, as well as the interictal burden of migraine.ResultsAmong the participants, 89.3% reported that galcanezumab treatment was beneficial for them. A decrease in the frequency (80.0%), severity (85.7%), and acute medication usage for migraine attacks (71.4%) was reported with galcanezumab treatment. An adverse effect related to galcanezumab was reported in 16.3% of cases, but no serious adverse reactions were observed. Remarkably, 14.3% of participants reported no longer experiencing any headaches, and 18.9% did not require any acute treatment while receiving galcanezumab treatment. A logistic regression model showed that male gender, lack of ictal nausea, and previous failure of more than 2 prophylactic agents may predict the non-responders.ConclusionsThe first large series from Turkey showed that galcanezumab treatment is safe and effective in most of the patients diagnosed with migraine by headache experts in the real-life setting. Patients reported a significant decrease in both ictal and interictal burden of migraine and expressed satisfaction with this treatment

Identification of Allodynic Migraine Patients with the Turkish Version of the Allodynia Symptom Checklist: Reliability and Consistency Study Allodini Varlığının Migren Hastalarında Allodini Semptom Anketi Tükçe Versiyonu (ASC/T) ile Saptanması: Geçerlilik

Introduction: Cutaneous allodynia is regarded as an expression of central sensitization in migraine. Although the gold standard is quantitative sensory testing, several practical assessment questionnaires have been developed to assess allodynia in migraine. We aimed to establish the first valid Turkish allodynia assessment questionnaire based on a 12-item allodynia symptom checklist and to evaluate the associated factors. Methods: The first part of the study included the translation and cultural adaptation of a Turkish version of the checklist. The Turkish version of the questionnaire was administered to 344 episodic and chronic migraine patients, who were chosen according to the International Classification of Headache Disorders -III beta criteria. Results: The total checklist score showed excellent test-retest reliability (r=0.821). The internal consistency of the checklist was assessed using Cronbach alpha values and was found to be acceptable (Cronbach alpha for the checklist=0.767). Data analysis revealed that 10 items of the questionnaire adequately identified allodynic subjects. Cutaneous allodynia was present in 218 (63.4%) migraine patients. Allodynia was more prominent in patients experiencing migraine with aura (p=0.008) and in females (p&lt;0.001). Multiple logistic regression analysis found that female gender, aura existence, longer headache duration, and higher attack frequency were the major determinants of cutaneous allodynia. Conclusion: Allodynia is common and has clinical significance in migraine; therefore, establishing a validated Turkish questionnaire for the assessment of allodynia was necessary. In this study, a Turkish version of the allodynia symptom checklist was validated and found to be convenient for the identification of allodynia in migraine patients. Keywords: Migraine, cutaneous allodynia, checklist, validity ABSTRACT Amaç: Kutanöz allodini migrende santral sensitizasyonun göstergesi olarak kabul edilmektedir. Altın standart kantitatif duysal test olmasına ragmen, migren hastalarında allodini araştırılması için geliştirilmiş çok sayıda anket bulunmaktadır. Bu çalışmada 12 madde içeren allodini semptom anketinin (ASC) Türkçeye uyarlanması ile ilk Türkçe geçerliliği gösterilmiş anketin geliştirilmesi ve ilişkili faktörlerin araştırılması amaçlandı. Yöntem: Çalışmanın birinci aşaması anketin Türkçe&apos;ye çevirisi ve kültürel adaptasyonunu içermektedir. İkinci aşamada, geliştirilen Türkçe anket Uluslarası Başağrısı Cemiyeti Başağrısı Sınıflandırması-3 beta (ICHD-3 beta)&apos;ya göre tanı almış 344 epizodik ve kronik migren hastasına uygulandı. Bulgular: Toplam anket skoru test-tekrar test değerlendirmesinde mü-kemmel güvenilirlik gösterdi (r=0,821). Anketin içsel tutarlılığı Kronbach Alfa Değeri ile değerlendirildi ve kabul edilebilir tutarlılık gösterdi (Anket Kronbach Alfa değeri: 0,767). Veri analizleri ankette bulunan 10 maddenin allodinik bireylerin tespit edilmesinde yeterli olduğunu gösterdi. Kutanöz allodini 218 migren hastasında (%63,4) saptandı. Allodini auralı migren hastalarında (p=0,008) ve kadınlarda daha sıktı (p&lt;0,001). Çok-lu lojistik regresyon analizinde kadın cinsiyet, aura varlığı, uzun başağrısı süresi ve sık atak sayısının kutanöz allodini varlığının başlıca belirleyicileri olduğu gösterildi. Sonuç: Allodininin migrende sık görülmesi ve klinik açıdan önemli olması nedeniyle geçerliliği gösterilmiş bir Türkçe allodini anketi bulunmasının gerekli olduğunu düşünmekteyiz. Bu çalışmada ASC-Türkçe versiyonunun geçerliliği ve migren hastalarında allodinin saptanmasında uygun bir anket olduğu gösterilmiştir

European Headache Federation (EHF) consensus on the definition of effective treatment of a migraine attack and of triptan failure

BACKGROUND: Triptans are migraine-specific acute treatments. A well-accepted definition of triptan failure is needed in clinical practice and for research. The primary aim of the present Consensus was to provide a definition of triptan failure. To develop this definition, we deemed necessary to develop as first a consensus definition of effective treatment of an acute migraine attack and of triptan-responder. MAIN BODY: The Consensus process included a preliminary literature review, a Delphi round and a subsequent open discussion. According to the Consensus Panel, effective treatment of a migraine attack is to be defined on patient well-being featured by a) improvement of headache, b) relief of non-pain symptoms and c) absence of adverse events. An attack is considered effectively treated if patient's well-being, as defined above, is restored within 2 hours and for at least 24 hours. An individual with migraine is considered as triptan-responder when the given triptan leads to effective acute attack treatment in at least three out of four migraine attacks. On the other hand, an individual with migraine is considered triptan non-responder in the presence of failure of a single triptan (not matching the definition of triptan-responder). The Consensus Panel defined an individual with migraine as triptan-resistant in the presence of failure of at least 2 triptans; triptan refractory, in the presence of failure to at least 3 triptans, including subcutaneous formulation; triptan ineligibile in the presence of an acknowledged contraindication to triptan use, as specified in the summary of product characteristics. CONCLUSIONS: The novel definitions can be useful in clinical practice for the assessment of acute attack treatments patients with migraine. They may be helpful in identifying people not responding to triptans and in need for novel acute migraine treatments. The definitions will also be of help in standardizing research on migraine acute care.info:eu-repo/semantics/publishedVersio

Primary And Secondary Prevention In Stroke: Approact To Diabetes Mellitus Cases

Microangiopathy and m acroangiopathy are induced by increased the tendency of atherosclerosis caused by metabolic impairment. The prerevalance of diabetes mellitus is 15 - 33 % in cases with ischemic stroke. Diabetes mellitus is an independent risk factor especially for stroke an d it can increase the relative risk (RR) 1.8 - 6 times for initial stroke. The risk of ischemic stroke is higher in women with diabetes. Individual adjustment of glycemic targets is performed but treatment regulation as to set ≤ 7.0 % of HbA1C is recommended for decreasing the microvascular and macrovascular complications if the history of stroke or TIA are present. The targeted fasting plasma glucose levels should be ranged from 4.0 to 7.0 mmol/L and the targeted plasma glucose levels at postprandial second hour should be ranged from 5.0 to 10.0 mmol/L. Daily physial activity, weight control, blood pressure control, lipid control and life style changes are recommended to all diabetic patients. Also, medical treatment is commonly needed for targeted HbA1C levels. In diabetic patients, Metformin is an effective first - line pharmacotherapy to decrease the stroke risk. Also, monotherapy with fibrates can be considered. It is proposed to set the blood preassure at < 130/80 mmHg with AC EI or ARB hypertension treatments in diabetic patients. Diabetic adults with additionally risk factors should be treated with statins to decrease the risk of initial stroke. The benefit of antiagregant usage to decrease the stroke risk is not clear yet, ho wever aspirin usage can suitable in diabetic patients with increased cardiovascular event risk

Do Comorbidities and Triggers Expedite Chronicity in Migraine?

Background and Aim: Several factors are suggested to be associated with an increased risk of transforming from episodic migraine (EM) to chronic migraine (CM). We aimed to examine whether some specific attack triggers and comorbidities were associated with CM. Methods: Patients followed up with a diagnosis of definite migraine for at least 1 year were divided into two groups, EM (15 attacks per month). The demographic and clinical data, attack‑triggering factors, and comorbid diseases were compared between the groups. Results: A total of 403 (286 females) patients were analyzed; 227 (56.3%) of the migraineurs had EM and 176 (43.7%) had CM. The mean age was 40.9 ± 11.3 years in EM, and 42.2 ± 11.7 years in CM. Disease duration was longer in CM compared with EM (P = 0.007). Missing meals (P = 0.044), exposure to heavy scents/perfumes (P = 0.012), intense physical activity (P = 0.037), and withdrawal of caffeine (P = 0.012) were reported significantly higher in CM than in EM. Comorbid history of medication overuse (P < 0.001), hypertension (P = 0.048), hyperlipidemia (P = 0.025), depression (P = 0.021), chronic painful health problems (P = 0.003), iron deficiency anemia (P = 0.006), and history of surgery (P = 0.006) were found significantly high in CM. Conclusion: This study demonstrates that attack‑triggering factors, vascular comorbidities, depression, medication overuse, and chronic painful health problems pose significant risks for CM. Vascular comorbidities are independent risk factors for chronification in migraine and might increase the patient’s lifetime morbidity and mortality. Therefore, prompt diagnosis of migraine before the transformation to chronicity and effective early management have the utmost importance

Clinical Approach to Painful Ophthalmoplegia: Literature Review in the Light of Case Examples

Scientific background and OBJECTIVE: Painful ophtalmoplegia is one of the important disorders that results in admissions to emergency department, neurologists and ophthalmologists. It comprises periorbital and/or frontotemporal severe pain, ipsilateral oculomotor nerve palsies, Horner syndrome and involvement of trigeminal nerve ophtalmic division. Various etiological factors affecting brain stem, cavernous sinus, superior orbital fissure, retroorbital fossa or all of them may result in painful ophtalmoplegia. MATERIALS-METHODS: We aim to present clinical, radiological and laboratory findings of 18 patients admittted to headache out-patient clinic of our department in last 2 years and review the literature. All cases underwent detailed neurological examination and radiological and extensive laboratory investigations and we performed lumbar puncture when needed. RESULTS: There were 10 female and 8 male patients. Clinical features and radiological and laboratory findings revealed Tolosa-Hunt syndrome in 7 cases, pseudo-tumor orbit in 1, pachymenengitis in 1, thyroid ophtalmopathy in 2, diabetic neuropathy in 1, carotico-cavernous fistula in 1, metastatic tumor in 2, aneurysm in 1, ophthalmoplegic migraine in 1 and intracranial hypotension in 1. CONCLUSION: Various etiological factors may underlie patients admitted with painful ophtalmoplegia, therefore cranial magnetic resonance imaging with gadolinium as well as lumbar puncture and biopsy when needed may have to be performed for differential diagnosi