Increased Risk of Dementia in Patients with Tension-Type Headache: A Nationwide Retrospective Population-Based Cohort Study

<div><p>Purpose</p><p>The association between primary headaches, including tension-type headache (TTH) as one of the most common primary headache disorders, and dementia remains controversial. In this nationwide, population-based, retrospective, cohort study, we explored the potential association between TTH and dementia and examined sex, age, and comorbidities as risk factors for dementia.</p><p>Methods</p><p>Using the Taiwan National Health Insurance Research Database (NHIRD) claims data, the sample included 13908 subjects aged ≥20 years with newly-diagnosed TTH in 2000–2006. The non-TTH group included 55632 randomly selected sex- and age-matched TTH-free individuals. All subjects were followed until dementia diagnosis, death, or the end of 2011. Patients with dementia, including vascular and non-vascular (including Alzheimer’s) subtypes, were identified using International Classification of Diseases Ninth Revision, Clinical Modification codes. Multivariate Cox proportional hazards regression models were used to assess the risk of dementia and dementia-associated risk factors, such as migraine and other medical comorbidities.</p><p>Results</p><p>During the average follow-up of 8.14 years, the incidence density rates of dementia were 5.30 and 3.68/1,000 person-years in the TTH and non-TTH groups, respectively. Compared with the non-TTH group, the risks of dementia were 1.25 (95% confidence interval [CI], 1.11–1.42) and 1.13 (95% CI, 1.01–1.27) times higher in the women and >65-year-old TTH group, respectively. TTH patients with comorbidities had a higher risk of dementia. TTH patients had a greater risk of non-vascular dementia (hazard ratio, 1.21; 95% CI, 1.09–1.34) than the non-TTH group.</p><p>Conclusion</p><p>TTH patients have a future risk of dementia, indicating a potentially linked disease pathophysiology that warrants further study. The association between TTH and dementia is greater in women, older adults, and with comorbidities. Clinicians should be aware of potential dementia comorbidity in TTH patients.</p></div

Baseline demographic factors and comorbidity of study participants according to tension-type headache status.

<p>Baseline demographic factors and comorbidity of study participants according to tension-type headache status.</p

Cox model measured hazard ratios and 95% confidence interval of dementia associated with tension-type headache and covariates.

<p>Cox model measured hazard ratios and 95% confidence interval of dementia associated with tension-type headache and covariates.</p

Incidence density rates and hazard ratios of dementia according to tension-type headache status stratified by sex, age, and comorbidity.

<p>Incidence density rates and hazard ratios of dementia according to tension-type headache status stratified by sex, age, and comorbidity.</p

Cumulative incidence curves of dementia for groups with and without tension-type headache.

<p>Cumulative incidence curves of dementia for groups with and without tension-type headache.</p

Incidence density rates and hazard ratios of dementia according to tension-type headache status.

<p>Incidence density rates and hazard ratios of dementia according to tension-type headache status.</p

Ultrasound-Guided Pulsed Radiofrequency for Carpal Tunnel Syndrome: A Single-Blinded Randomized Controlled Study

<div><p>Objective</p><p>We assessed the therapeutic efficiency of ultrasound-guided pulsed radiofrequency (PRF) treatment of the median nerve in patients with carpal tunnel syndrome (CTS).</p><p>Methods</p><p>We conducted a prospective, randomized, controlled, single-blinded study. Forty-four patients with CTS were randomized into intervention or control groups. Patients in the intervention group were treated with PRF and night splint, and the control group was prescribed night splint alone. Primary outcome was the onset time of significant pain relief assessed using the visual analog scale (VAS), and secondary outcomes included evaluation of the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) results, cross-sectional area (CSA) of the median nerve, sensory nerve conduction velocity (SNCV) of the median nerve, and finger pinch strength. All outcome measurements were performed at 1, 4, 8, and 12 weeks after treatment.</p><p>Results</p><p>Thirty-six patients completed the study. The onset time of pain relief in the intervention group was significantly shorter (median onset time of 2 days vs. 14 days; hazard ratio = 7.37; 95% CI, 3.04–17.87) compared to the control group (p < 0.001). Significant improvement in VAS and BCTQ scores (p < 0.05) was detected in the intervention group at all follow-up periods compared to the controls (except for the severity subscale of BCTQ at week 1). Ultrasound-guided PRF treatment resulted in a lower VAS score and stronger finger pinch compared to the control group over the entire study.</p><p>Conclusions</p><p>Our study shows that ultrasound-guided PRF serves as a better approach for pain relief in patients with CTS.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT02217293" target="_blank">NCT02217293</a></p></div

a: Positioning of the ultrasonographic transducer and radiofrequency needle.

<p>b: Real-time imaging of the ultrasound-guided needle insertion.</p

Functional outcomes of patients with acute stroke in the presence of ROAF or intracranial stenosis.

<p>Patients with acute stroke were divided into 4 subgroups: severe intracranial stenosis (>50%) and forward OA, severe intracranial stenosis (>50%) and reversed OA, mild intracranial stenosis (≤50%) and forward OA, and mild intracranial stenosis (≤50%) and reversed OA.ROAF and less intracranial stenosis are good predictors for acute stroke outcomes. mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; no., number; OA, ophthalmic artery; <i>*</i>p = p value for trend. Statistically significant differences were evaluated using Fisher's exact test for categorical variables between the tested groups and Mantel–Haenszel extension tests for trend analyses. ^ap<0.05 vs. forward OA and intracranial stenosis >50%; ^bp<0.01 vs. forward OA and intracranial stenosis >50%; ^cp<0.05 vs. reversed OA and intracranial stenosis >50%; ^dp<0.01 vs. reversed OA and intracranial stenosis >50%.</p

Study patient selection.

<p>FOAF, forward ophthalmic artery flow; MR, magnetic resonance; ROAF, reversed ophthalmic artery flow; EC-IC bypass, extracranial–intracranial bypass.</p