Predictive Factors and the Role of Traumatic Brain Injury in Stroke.

Background: Traumatic brain injury (TBI) is the leading cause of mortality and invalidity worldwide. Objective: To explore whether traumatic brain injury may be a risk factor for subsequent stroke and to evaluate the role of other risk factors correlated with TBI and stroke. Methods: We analysed 643 patients presented in the emergency department of Trauma UHC, from 1stof June 2011 - 1st of December 2011. We evaluated the following factors: age, gender, and severity of head trauma, type of head trauma, systemic hypertension, atrial fibrillation, and diabetes mellitus. Results: During 1-year of follow upperiod 32 (4.97%) strokes occurred in TBI patients. The evaluation was done in correlation with the other risk factors taken into account in the study. Conclusions: The role of TBI is underestimated in the evaluation of stroke. This study demonstrated that during the first year after TBI, 13.53 % of patients experienced stroke. After careful statistical cor-relations with the selected co-morbidities, we found that the diagnosis of stroke was strongly related with TBI

Burden and attitude to resistant and refractory migraine: a survey from the European Headache Federation with the endorsement of the European Migraine & Headache Alliance

Background: New treatments are currently offering new opportunities and challenges in clinical management and research in the migraine field. There is the need of homogenous criteria to identify candidates for treatment escalation as well as of reliable criteria to identify refractoriness to treatment. To overcome those issues, the European Headache Federation (EHF) issued a Consensus document to propose criteria to approach difficult-to-treat migraine patients in a standardized way. The Consensus proposed well-defined criteria for resistant migraine (i.e., patients who do not respond to some treatment but who have residual therapeutic opportunities) and refractory migraine (i.e., patients who still have debilitating migraine despite maximal treatment efforts). The aim of this study was to better understand the perceived impact of resistant and refractory migraine and the attitude of physicians involved in migraine care toward those conditions. Methods: We conducted a web-questionnaire-based cross-sectional international study involving physicians with interest in headache care. Results: There were 277 questionnaires available for analysis. A relevant proportion of participants reported that patients with resistant and refractory migraine were frequently seen in their clinical practice (49.5% for resistant and 28.9% for refractory migraine); percentages were higher when considering only those working in specialized headache centers (75% and 46% respectively). However, many physicians reported low or moderate confidence in managing resistant (8.1% and 43.3%, respectively) and refractory (20.7% and 48.4%, respectively) migraine patients; confidence in treating resistant and refractory migraine patients was different according to the level of care and to the number of patients visited per week. Patients with resistant and refractory migraine were infrequently referred to more specialized centers (12% and 19%, respectively); also in this case, figures were different according to the level of care. Conclusions: This report highlights the clinical relevance of difficult-to-treat migraine and the presence of unmet needs in this field. There is the need of more evidence regarding the management of those patients and clear guidance referring to the organization of care and available opportunities