Spatial Distribution of Temporalis Pressure Pain Sensitivity in Men with Episodic Cluster Headache

Background: Spatial changes in pressure sensitivity have been described in migraine and tension-type headaches. Our aim was to determine differences in the spatial distribution of pressure pain sensitivity of the temporalis muscle between cluster headache (CH) patients and headache-free controls. Methods: Pressure pain thresholds (PPTs) were determined over nine points covering the temporalis muscle in 40 men with episodic CH and 40 matched headache-free controls in a blinded fashion. Topographical pressure pain sensitivity maps were constructed based on interpolation of the PPTs. Patients were evaluated in a pain-free period (remission phase), at least 3 months from the last attack and without medication. Results: The analysis of covariance (ANCOVA) found significant difference between points (F = 21.887; P 0.8). Conclusions: Bilateral pressure pain hypersensitivity to pressure pain in the temporalis muscle and an anterior-to-posterior gradient to pressure pain was observed in men with episodic CH.s

Falls Predict Acute Hospitalization in Parkinson's Disease

[Background] There is a need for identifying risk factors for hospitalization in Parkinson’s disease (PD) and also interventions to reduce acute hospital admission.[Objective] To analyze the frequency, causes, and predictors of acute hospitalization (AH) in PD patients from a Spanish cohort.[Methods] PD patients recruited from 35 centers of Spain from the COPPADIS-2015 (COhort of Patients with PArkinson’s DIsease in Spain, 2015) cohort from January 2016 to November 2017, were included in the study. In order to identify predictors of AH, Kaplan-Meier estimates of factors considered as potential predictors were obtained and Cox regression performed on time to hospital encounter 1-year after the baseline visit.[Results] Thirty-five out of 605 (5.8%) PD patients (62.5±8.9 years old; 59.8% males) presented an AH during the 1-year follow-up after the baseline visit. Traumatic falls represented the most frequent cause of admission, being 23.7% of all acute hospitalizations. To suffer from motor fluctuations (HR [hazard ratio] 2.461; 95% CI, 1.065–5.678; p = 0.035), a very severe non-motor symptoms burden (HR [hazard ratio] 2.828; 95% CI, 1.319–6.063; p = 0.008), falls (HR 3.966; 95% CI 1.757–8.470; p = 0.001), and dysphagia (HR 2.356; 95% CI 1.124–4.941; p = 0.023) was associated with AH after adjustment to age, gender, disease duration, levodopa equivalent daily dose, total number of non-antiparkinsonian drugs, and UPDRS-IIIOFF. Of the previous variables, only falls (HR 2.998; 95% CI 1.080–8.322; p = 0.035) was an independent predictor of AH.[Conclusion] Falls is an independent predictor of AH in PD patients.Peer reviewe

Procesamiento somatosensorial en pacientes tratados mediante ultrasonido focal de alta intensidad: efecto lesional y tremórico sobre el umbral de discriminación temporal somatosensorial

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Anatomía, Histología y Neurociencia. Fecha de Lectura: 16-07-2024Esta tesis tiene embargado el acceso al texto completo hasta el 16-01-2026El umbral de discriminación temporal somatosensorial (UDTS) mide la capacidad de detección de dos estímulos somatosensoriales separados en el tiempo. Sus valores normales oscilan entre 30 y 80ms, y se han observado patológicamente aumentados en casos de enfermedad de Parkinson (EP) y distonía, mientras que en el temblor esencial (TE) se mantienen dentro de la normalidad. El tratamiento dopaminérgico en la EP mejora los valores del UDTS, no así la estimulación cerebral profunda del núcleo subtalámico, que no induce cambios sobre el UDTS en condiciones OFF medicación, y empeora la mejoría habitual inducida por levodopa. Este hecho se ha atribuido a la degradación del procesamiento temporal somatosensorial en la interacción cortico-subcortico-cortical debido a la estimulación eléctrica. Nuestro objetivo principal fue determinar el posible efecto sobre el UDTS de la nueva técnica termoablativa de tratamiento con ultrasonido focal de alta intensidad (HIFU) en pacientes afectados de EP y TE. Como objetivo secundario, quisimos explorar el posible efecto del temblor sobre la aferencia propioceptiva como fenómeno de “puerta de entrada”, midiendo el UDTS en estados tremórico y no tremórico en ambas muestras. Se estudiaron 20 pacientes con EP marcadamente asimétrica tratados mediante subtalamotomía unilateral para el lado corporal más afectado, y 20 pacientes con TE tratados mediante talamotomía VIM unilateral izquierda para el tratamiento del temblor en el miembro superior derecho. Se estudió el UDTS basalmente en estados tremórico y no tremórico en el lado tratado y en estado no tremórico en el lado no tratado (la muestra de TE constó de 34 pacientes para esta determinación, incluyendo los 20 mencionados). Se comparó la determinación del UDTS en ambos lados en estado no tremórico previa y 3-4 meses posterior a la realización de la lesión. Los resultados se compararon además con muestras control de 20 pacientes para cada cohorte. Adicionalmente, se estudió la relación de la variación del UDTS con el potencial evocado somatosensorial (PESS) a nivel cortical y con las características del temblor entre los estados tremórico y no tremórico en 14 pacientes con TE. En la cohorte de EP el UDTS descendió significativamente en 23,3ms en el lado tratado con un valor final que no difirió del valor en controles; el UDTS no varió significativamente en el lado no tratado. En la cohorte de TE el UDTS no se modificó significativamente tanto en el lado tratado como en el lado no tratado, y no difirió de los valores control. Los valores del UDTS en estados tremórico y no tremórico no fueron diferentes en la cohorte de EP y aumentaron significativamente en 33,1ms en el estado tremórico en la cohorte de TE. Este aumento del UDTS se corroboró en la muestra de 14 pacientes adicionales, donde se correlacionó además con la disminución de la amplitud de la onda N20 de los PESS y con la amplitud del temblor. En nuestro estudio, el UDTS se normalizó tras la subtalamotomía por HIFU en pacientes con EP y no se modificó tras la talamotomía por HIFU en pacientes con TE. La subtalamotomía podría regular los circuitos aberrantes presentes en la EP de una forma más precisa y menos compleja que la estimulación subtalámica. El temblor empeoró el UDTS en los pacientes con TE, con un correlato con la atenuación de la onda N20 de los PESS y con la amplitud del temblor, reforzando el fenómeno de “puerta de entrada” del temblor a nivel cortical en esta cohort

Network Analysis Reveals That Headache-Related, Psychological and Psycho–Physical Outcomes Represent Different Aspects in Women with Migraine

Evidence supports that migraine is a complex pain condition with different underlying mechanisms. We aimed to quantify potential associations between demographic, migraine-related, and psychophysical and psychophysical variables in women with migraine. Demographic (age, height, and weight), migraine-related (intensity, frequency, and duration), related-disability (Migraine Disability Assessment Scale, Headache Disability Inventory), psychological (Hospital Anxiety and Depression Scale), and psycho–physical (pressure pain thresholds -PPTs-) variables were collected from a sample of 74 women suffering from migraine. We calculated adjusted correlations between the variables by using a network analysis. Additionally, we also calculated centrality indices to identify the connectivity among the variables within the network and the relevance of each variable in the network. Multiple positive correlations (ρ) between PPTs were observed ranging from 0.1654 (C5-C6 and tibialis anterior) to 0.40 (hand and temporalis muscle). The strongest associations within the network were those between migraine attack frequency and diagnosis of chronic migraine (ρ = 0.634) and between the HDI-E and HDI-P (ρ = 0.545). The node with the highest strength and betweenness centrality was PPT at the second metacarpal, whereas the node with the highest harmonic centrality was PPT at the tibialis anterior muscle. This is the first study applying a network analysis to understand the underlying mechanisms in migraine. The identified network revealed that a model where each subgroup of migraine-related, psychological, and psycho–physical variables showed no interaction between each variable. Current findings could have clinical implications for developing multimodal treatments targeting the identified mechanisms

Real-world experience of OnabotulinumtoxinA treatment in female patients with chronic migraine: a qualitative study using in-depth interviews

AbstractBackground Chronic migraine (CM) causes great disability and affects an individual’s quality of life. OnabotulinumtoxinA (OBT-A, Botox®) was the first prophylactic treatment specifically indicated for CM. The aim of this study was to describe the experiences of women with CM treated with OBT-A.Materials and Methods The study design is a qualitative descriptive study. A purposeful sampling of 30 women (mean age, 42.7; standard deviation, 10.6) who had received at least two administrations of OBT-A for CM (PREEMPT protocol) was performed. Data collection included in-depth interviews and researchers’ field notes. A thematic analysis was carried out according to qualitative research guidelines.Results Five themes were identified: (a) A long way to go before Botox®, (b) First time hearing about the treatment and its expectations, (c) The administration of Botox®, (d) Treatment effects, and (e) Follow-up. Patients described a long history of treatment failures prior to the start of OBT-A treatment. Information about this migraine treatment came from the neurologist; following the information, patients had high expectations, including unrealistic expectations regarding the onset and duration of effect. They acknowledged fear of the injections and some discomfort due to the procedure. With treatment, participants reported better migraine control and an improvement in their quality of life. Follow-up had some barriers, such as delayed appointments for subsequent doses, but also strengths, such as effectiveness and few side effects.Conclusions Qualitative research offers insight into how patients with CM experience treatment with OBT-A. Our results highlight some relevant aspects that should be considered when providing OBT-A treatment

Path Analysis Models Integrating Psychological, Psycho-physical and Clinical Variables in Individuals With Tension-Type Headache.

Tension type headache (TTH) is a prevalent but poorly understood pain disease. Current understanding supports the presence of multiple associations underlying its pathogenesis. Our aim was to compare competing multivariate pathway models that explains the complexity of TTH. Headache features (intensity, frequency, or duration - headache diary), headache-related disability (Headache Disability Inventory-HDI), anxiety/depression (Hospital Anxiety and Depression Scale), sleep quality (Pittsburgh Sleep Quality Index), widespread pressure pain thresholds (PPTs) and trigger points (TrPs) were collected in 208 individuals with TTH. Four latent variables were formed from the observed variables - Distress (anxiety, depression), Disability (HDI subscales), Severity (headache features), and Sensitivity (all PPTs). Structural equation modelling (SEM) and Bayesian network (BN) analyses were used to build and compare a theoretical (modeltheory) and a data-driven (modelBN) latent variable model. The modelBN (root mean square error of approximation [RMSEA] = 0.035) provided a better statistical fit than modeltheory (RMSEA = 0.094). The only path common between modelbn and modeltheory was the influence of years with pain on TrPs. The modelBN revealed that the largest coefficient magnitudes were between the latent variables of Distress and Disability (β=1.524, P = .006). Our theoretical model proposes a relationship whereby psycho-physical and psychological factors result in clinical features of headache and ultimately affect disability. Our data-driven model proposes a more complex relationship where poor sleep, psychological factors, and the number of years with pain takes more relevance at influencing disability. Our data-driven model could be leveraged in clinical trials investigating treatment approaches in TTH. Perspective: A theoretical model proposes a relationship where psycho-physical and psychological factors result in clinical manifestations of headache and ultimately affect disability. A data-driven model proposes a more complex relationship where poor sleep, psychological factors, and number of years with pain takes more relevance at influencing disability