COVID-19 vaccination-related headache showed two different clusters in the long-term course: A prospective multicenter follow-up study (COVA-Head Study)

BackgroundAlthough acute headache following COVID-19 vaccination is widely acknowledged, the long-term progression of these headaches remains poorly understood. Our objective was to identify various phenotypes of prolonged or worsened headaches associated with COVID-19 vaccination and document any changes in these phenotypes over an extended period. Additionally, we aimed to document the diverse headache presentations among patients with pre-existing primary headaches.MethodsA multinational, prospective observational study was conducted to investigate prolonged or worsened headaches associated with COVID-19 vaccination. Questionnaires assessing COVID-19 vaccination-related headaches at three time points (initial visit, 3rd month follow-up, and 6th month follow-up) were developed for the study. Headache specialists/clinicians evaluated patients using these questionnaires in a prospective manner. Repeated K-means cluster analysis was performed to identify patient profiles with prolonged or worsened headaches related to COVID-19 vaccination.ResultsAmong the 174 patients included in the study, there was a female-to-male ratio of 128 (73.6%) to 46 (26.4%). The mean age of the patient group was 45.2 +/- 13.3 years, and 107 patients (61.5%) had a pre-existing history of primary headaches. Through the analysis, two major clusters were identified based on headache characteristics at each visit. During the first visit (n = 174), Cluster 1 primarily comprised patients with a history of primary headaches, frontal localization of pain, throbbing pain type, more severe headaches accompanied by symptoms such as nausea, phonophobia, photophobia, and osmophobia, and worsened by physical activity. In contrast, Cluster 2 consisted of patients with longer headache durations (over one month) and a stabbing/pressing quality of pain. Patients in Cluster 1 had a higher prevalence of migraine as the pre-existing primary headache disorder compared to Cluster 2 (90.48% vs. 68.18%, respectively; p = 0.005).ConclusionThe identification of two distinct phenotypes of prolonged or worsened headaches related to COVID-19 vaccination can provide valuable clinical insights. Having an awareness of the potential worsening of headaches following COVID-19 vaccination, particularly in patients with a primary headache disorder such as migraine, can help clinicians and headache experts anticipate and adjust their treatment strategies accordingly. This knowledge can aid in preplanning treatment modifications and optimize patient care

Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (<4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs

Immunotherapy Responsive Epilepsies: General Clinical Features, Commonly Detected Antibodies and Treatment Studies

The role of immunity and inflammation in epilepsy has long been considered and in recent years, discovery of some antibodies against to various neuronal antigens especially in cases refractory to conventional anti-epileptic drugs raised the concept of “autoimmune epilepsy”. Immunotherapy may lead to significant benefits in cases with suspicion of autoimmune etiology. In this paper, epileptic pictures with a known autoimmune aspect as well as those pictures with recent increased awareness due to the discovery of neuronal auto-antibodies responding to immunotherapies and their management options are summarized

Epilepsy and Autoimmunity

Epilepsy may present as a symptom of many neurological disorders and often an etiological factor cannot be identified. There is some evidence that immune mechanisms might play a role in the pathogenesis of certain epileptic syndromes. The evidence in support of this idea includes apparent association of seizures with certain autoimmune diseases, numerous reports of the detection of theoretically relevant serum autoantibodies, an acute or subacute onset of the seizures, a rapidly progressive course, and a favorable response to immunotherapy. In this article, we summarize (i) epilepsies where clinical and biologic data strongly support the pathogenic role of autoantibodies. (ii) epilepsies where immune-mediated inflammation occurs, but the full pathogenic cascade is either not clear or only strongly hypothesized and (iii) autoimmune diseases associated with seizures or epilepsy

Çocukluk Çağında İnflamatuar Demiyelinizan Hastalıklar: Olgu Sunumu ve Literatürün Gözden Geçirilmesi

Multiple sclerosis (MS) and acute disseminated encephalomyelitis (ADEM) are demyelinating inflammatory diseases, considered to have a striking pathophysiological resemblance. However, due to the differences in both clinical course and clinical approaches, it is important to differentiate between the two conditions, to plan further investigations and therapy protocols. These diseases have similar but also distinct clinical, radiological and cerebrospinal fluid (CSF) findings. ADEM is typically a monophasic disease of children. MS occurs generally in adult age, but uncommonly may develop in childhood with variable features. Our case is a 14 year-old-girl, presented with a three-month history of left hemiparesis, followed by right hemiparesis, cerebellar signs, myelitis and cortical visual disturbances. Based on the clinical follow-up, MR and CSF findings, our patient was diagnosed with relapsing tumefactive multiple sclerosis. Steroid treatment was not significantly effective, however the patient has benefited from plasmapheresis clinically and radiologically. Our patient is still being followed under the disease modifying therapy without any relapse

GENÇ HEMORAJİK İNME OLGULARININ KLİNİK VE DEMOGRAFİK ÖZELLİKLERİ

Amaç:Tüm inmelerin yaklaşık %15’ini oluşturan genç inmeler, altta yatan etiyolojik çeşitlilik ve neden olduğu özürlülük ile buna bağlı sosyoekonomik sorunlar nedeniyle özellikli bir yere sahiptir. Genç inmeler içinde daha küçük bir grup olan hemorajik inmelerde prognoz ve rekürrens iyi bilinmemektedir. Bu çalışmada genç hemorajik inme olgularının demografik ve klinik özelliklerinin değerlendirilmesi amaçlanmıştırGereç ve Yöntem:Bu çalışmaya 2000 -2020 yılları arasında İstanbul Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı Dr. Edip Aktin İnme ünitesinde yatırılarak izlenmiş ve poliklinik takibi olan 50 yaşın altındaki inme hastaları dahil edildi. Bu hastaların demografik özellikleri, klinik ve görüntüleme bulguları retrospektif olarak değerlendirildi. Serebral venöz tromboz tanılı hastalar çalışmaya dahil edilmedi.Bulgular:İncelenen 246 genç inme hastasının 18’i (%7.3) hemorajik inme tanısı almıştır. Bu hastaların 9’u erkek (%50), inme anındaki yaş ortalaması 40.3±6.9 idi. Bir hastada iskemik bir hastada hemorajik inme öyküsü, 6 hastada ise ailede inme öyküsü vardı. Hastaların başvuru sırasında NIHSS skoru ortalaması 10.3±6.7 saptandı. Hematom lokalizasyonu değerlendirildiğinde; 12 hastada derin, 4 hastada lober ve 2 hastada ise arka sistem (pons ve serebellum) yerleşimli olduğu izlendi. Dokuz erkek (hematom saptanan tüm erkekler), 5 kadın toplam 14 hastada etiyoloji hipertansiyondu. Kadın hastaların ikisi gebelik döneminde hemorajik inme (eklempsi, antikoagülan ilişkili) geçirmişti. Bir hastada post partum dönemde hipertansif, bir hasta postpartum dönemde reversible serebral vazokonstriksiyon sendromuna (RSVS) bağlı, bir hastada antidepresan kullanımı ilişkili RSVS bağlı, bir hastada ise Moya Moya hastalığına bağlı hemorajik inme saptandı. Çıkışta üç hastanın Modifiye Rankin Skalası (mRS) skoru 5, dokuz hastanın mRS skoru 4, kalan hastaların mRS skorları 0-2 arasındaydı. Ortalama takip süresi 49.7±50.95 (değer aralığı: 3-168 ay) olup, uzun dönem izlemde iki hastanın mRS skoru 4, dokuz hastanın 3; kalan hastaların mRS skorları 0-2 arasında idi. İzlemde hastaların hiçbirinde iskemik ya da hemorajik inme tekrarı gelişmedi.Sonuç:Hasta sayısı az olmakla birlikte izlem süresinin uzun olduğu bu çalışmada, genç hemorajik inme olgularında en sık nedenin, yaşlılara benzer şekilde hipertansiyon olduğu görüldü. Kadın hastaların yaklaşık yarısında intraserebral kanamanın gebelik veya post partum dönemde geliştiği dikkati çekmiştir. Genç inmelerde, bilinen etiyolojilerinin yanı sıra RSVS, Moya Moya hastalığı gibi nadir nedenler de akla gelmelidir