Headaches attributed to airplane travel:a Danish survey

BACKGROUND: Airplane headache (AH) is a headache that occurs during take-off and landing. The pain is described as severe, unilateral, and located in the fronto-orbital region. This study aimed at investigating the incidence of AH among Scandinavian air-travelers, and to elucidating potential risk factors. METHODS: An online, Danish-survey was developed. The questionnaire consisted of 14 questions and was distributed through the Facebook-pages of Scandinavian-airlines and interest organizations. Participants reached the questionnaire through a web-link. RESULTS: Out of 254 responses, 89 noted that they suffered from headaches associated to airplane travel. Of the 89, 21 cases the headache was severe and limited to 30 min duration, as described in the ICH’s criteria of AH. The remaining 68 cases indicated that the headache lasted longer than 30 min. Our data demonstrated that High-Altitude Headache (HAH) is a risk factor for developing AH (p < 0.05). Triptans (19 %) and paracetamol (5 %) were reported effective to relieve AH. CONCLUSION: This study indicates that up to 8.3 % of the studied population suffered from AH, with a higher incidence in those with a history of HAH. Self-medication by triptans and paracetamol were reported effective for relieving AH

Simulated airplane headache:a proxy towards identification of underlying mechanisms

BACKGROUND: Airplane Headache (AH) occurs during flights and often appears as an intense, short lasting headache during take-off or landing. Reports are limited on pathological mechanisms underlying the occurrence of this headache. Proper diagnosis and treatments would benefit from identification of potential pathways involved in AH pathogenesis. This study aimed at providing a simulated airplane headache condition as a proxy towards identification of its underlying mechanisms. METHODS: Fourteen participants including 7 volunteers suffering from AH and 7 healthy matched controls were recruited after meeting the diagnostic and safety criteria based on an approved study protocol. Simulation of AH was achieved by entering a pressure chamber with similar characteristics of an airplane flight. Selected potential biomarkers including salivary prostaglandin E(2) (PGE(2)), cortisol, facial thermo-images, blood pressure, pulse, and saturation pulse oxygen (SPO) were defined and values were collected before, during and after flight simulation in the pressure chamber. Salivary samples were analyzed with ELISA techniques, while data analysis and statistical tests were handled with SPSS version 22.0. RESULTS: All participants in the AH-group experienced a headache attack similar to AH experience during flight. The non-AH-group did not experience any headaches. Our data showed that the values for PGE(2), cortisol and SPO were significantly different in the AH-group in comparison with the non-AH-group during the flight simulation in the pressure chamber. CONCLUSION: The pressure chamber proved useful not only to provoke AH-like attack but also to study potential biomarkers for AH in this study. PGE(2), and cortisol levels together with SPO presented dysregulation during the simulated AH-attack in affected individuals compared with healthy controls. Based on these findings we propose to use pressure chamber as a model to induce AH, and thus assess new potential biomarkers for AH in future studies

Botulinum neurotoxin type A modulates vesicular release of glutamate from satellite glial cells

This study investigated the presence of cell membrane docking proteins synaptosomal-associated protein, 25 and 23 kD (SNAP-25 and SNAP-23) in satellite glial cells (SGCs) of rat trigeminal ganglion; whether cultured SGCs would release glutamate in a time- and calcium-dependent manner following calcium-ionophore ionomycin stimulation; and if botulinum neurotoxin type A (BoNTA), in a dose-dependent manner, could block or decrease vesicular release of glutamate. SGCs were isolated from the trigeminal ganglia (TG) of adult Wistar rats and cultured for 7 days. The presence of SNAPs in TG sections and isolated SGCs were investigated using immunohistochemistry and immunocytochemistry, respectively. SGCs were stimulated with ionomycin (5 μM for 4, 8, 12 and 30 min.) to release glutamate. SGCs were then pre-incubated with BoNTA (24 hrs with 0.1, 1, 10 and 100 pM) to investigate if BoNTA could potentially block ionomycin-stimulated glutamate release. Glutamate concentrations were measured by ELISA. SNAP-25 and SNAP-23 were present in SGCs in TG sections and in cultured SGCs. Ionomycin significantly increased glutamate release from cultured SGCs 30 min. following the treatment (P < 0.001). BoNTA (100 pM) significantly decreased glutamate release (P < 0.01). Results from this study demonstrated that SGCs, when stimulated with ionomycin, released glutamate that was inhibited by BoNTA, possibly through cleavage of SNAP-25 and/or SNAP-23. These novel findings demonstrate the existence of vesicular glutamate release from SGCs, which could potentially play a role in the trigeminal sensory transmission. In addition, interaction of BoNTA with non-neuronal cells at the level of TG suggests a potential analgesic mechanism of action of BoNTA

Pain assessment and post-operative pain management in orthopedic patients

Abstract Aims A fast-track based surgical treatment reduces morbidity and hospital stay by providing early mobilization. Sufficient postoperative pain management is mandatory for early mobilization and optimal utilization of rehabilitation measures. Insufficient postoperative pain management is however a widespread problem. Lack of knowledge about pain and pain treatment among health care professionals and general community has been considered as a major potential contributor in insufficient pain management. It has been suggested that severe postoperative pain might imply a potential risk of developing chronic pain. The purpose of this study was to examine this problem in acute and elective surgical patients in department of orthopedic surgery at Bispebjerg Hospital in order to identify obstacles and possibilities for future improvement. Methods Questionnaires were developed and distributed to patients consisted of 10 acute admitted and 10 elective orthopedic patients. The patients’ pain scores were recorded with a 0–10 NRS scale. The scores were obtained for current pain in rest, current pain in activity, and the highest and lowest pain intensity for the last 24 hours. Data were handled using descriptive statistics. Results The goal for sufficient pain treatment was patients with pain score at ≤ 3 NRS at rest and ≤ 5 in activity. For pain at rest 45% of the patients were within the goal range and 55% for the current pain in activity. For the mildest pain experienced in the last 24 h, 75% and for the worst pain experienced 30% of the patients reached the goal. Conclusions Corresponding to similar studies, half of the patients received a sufficient pain treatment at the time of examination. The consequences for insufficient pain management would be reduced effect of the physiotherapy, reduced ability to handle every day activity, sleep disturbances, and potential risk of developing chronic pain. </jats:sec