History of cluster headache

Objective: To summarise the history of cluster headache evolving concepts and growing insights. Background: Excruciating pain, activation of the parasympathetic nervous system, and circadian rhythmicity characterise cluster headache attacks. Results: We find the oldest descriptions of patients suffering from the disorder in case reports of the 17th and 18th centuries. Only in the 19th and early 20th centuries did physicians start hypothesizing its cause. Initially, many researchers suspected the origin of the pain in peripheral nerves or blood vessels. However, eventually, they understood that the cause of the disease lies in the brain. In 1998, Positron emission tomography studies revealed increased activity of the posterior hypothalamus, whose role remains incompletely understood. Only recently have researchers realised that being diseased implies more than dysfunction. Recent studies analysed the consequences of cluster headache for each patient. Many struggle to deal with the disorder even in the absence of pain. Conclusion: Physicians have been aware of this type of pain for at least 300 years. Only when researchers studied pathological anatomy and physiology did knowledge accrue. A more comprehensive picture of the disease severity emerged when they also considered its consequences

Approaching Headaches—A Guide to Differential-Diagnostic Considerations and Causal Claims

Headaches can be nociplastic, neuropathic, and nociceptive. Pain related to the latter two categories occurs in the presence of nerve lesions and nociceptive stimuli; attributing pain to the last category requires a list of potential causes and arguments supporting the causal claim. Taking a history and examining patients serves to assess diagnostic criteria and screen for disorders whose diagnosis requires additional examinations. Screening information occurs in two types: one indicates that patients have a headache due to another condition; the other suggests they are at risk. Aspiring to make causal claims for a headache is reasonable because if underlying disorders appear independently and randomly, it is probable that there is only one cause. Thus, having found a cause often implies having found the cause. The prerequisites for causal claims are temporal sequencing, correlation, and elimination of alternate causes. Mechanistic, manipulative, and probabilistic evidence supports the second criterion. The importance of headaches lies in their frequent appearance as an early symptom of an incipient disorder (“sentinel symptom”). Hence, they provide the opportunity to diagnose early diseases with potentially deleterious consequences. Thus, it is sensible to assess each attack carefully and systematically

Red flags in headache care

Keywords: diagnosis; secondary headache; sensitivity; specificit

Learned Helplessness and Cluster Headache – A Case Report

Spontaneous coronary artery dissection (SCAD) has long been recognized as a cause of acute coronary syndromes (ACS) with very low prevalence (3% in most cohorts). It predominantly occurs in young to middle-aged women. SCAD patients have fewer traditional cardiovascular risk factors for ischaemic heart disease than patients with atherosclerotic coronary artery disease, however, many patients do have some risk factors for ischaemic heart disease including hypertension, smoking, and dyslipidaemia, although there is no evidence these contribute directly to the risk of SCAD. We report in this case an observation of spontaneous coronary dissection, in order to discuss its pathogenesis, diagnosis and management

Polyp Resection - Controversial Practices and Unanswered Questions

Detection and complete removal of precancerous neoplastic polyps are central to effective colorectal cancer screening. The prevalence of neoplastic polyps in the screening population in the United States is likely 450%. However, most persons with neoplastic polyps are never destined to develop cancer, and do not benefit for finding and removing polyps, and may only be harmed by the procedure. Further 70–80% of polyps are diminutive (≤5 mm) and such polyps almost never contain cancer. Given the questionable benefit, the high-cost and the potential risk changing our approach to the management of diminutive polyps is currently debated. Deemphasizing diminutive polyps and shifting our efforts to detection and complete removal of larger and higher-risk polyps deserves discussion and study. This article explores three controversies, and emerging concepts related to endoscopic polyp resection. First, we discuss challenges of optical resect-and-discard strategy and possible alternatives. Second, we review recent studies that support the use of cold snare resection for ≥ 5 mm polyps. Thirdly, we examine current evidence for prophylactic clipping after resection of large polyps

Praxis-Modellvorhaben: Einführung von QM-Systemen zur Sicherstellung von Rückverfolgbarkeit und erlebter Frischequalität in regionalen Ökogemüse-Ketten im LEH und NEH

Bereich Dokumentation Als Ergebnis einer Marktrecherche und Tests verschiedener EDVAckerschlagkarteien wurde die Kooperation mit dem Agrar-Softwarehersteller „Helm- Software” aufgebaut. Zusammen mit Projektbetrieben, die das Programm „MultiPlant” testeten, den Lebensmittelhändlern und Projektpartnern tegut... und Ökoring sowie verschiedenen Öko-Kontrollstellen wurden Vorgaben zur Anpassung des Programms an die Bedingungen des ökologischen Landbaus erarbeitet und im Programm umgesetzt. Wichtige Leistungsparameter sind: effektive Datenerfassung und Auswertung, Chargenkodierung, Schnittstellen zu Öko-Kontrolle, Rückverfolgbarkeitssystemen, Agrar-Förderbehörden. Das neue Programm „MultiPlant Bio” konnte erfolgreich auf dem Markt eingeführt und die weitere Entwicklung sichergestellt werden. Eine telefonische Hotline wurde aufgebaut und ein Schulungskonzept erfolgreich getestet. Die Ergebnisse der Projektteile wurden in einem Frische-QM-Handbuch zusammengefasst. Darin stehen den Erzeugerbetrieben Arbeitshilfen, Checklisten und eine Anleitung zum Aufbau der betrieblichen Dokumentation unter besonderer Berücksichtigung der Rückverfolgbarkeit zur Verfügung und es enthält den Leitfaden zur Frischeerhaltung entlang der Handelskette von frischem Gemüse. Bereich Frischemessungen Obst und Gemüse sind nach der Ernte aus den verschiedensten Gründen besonders empfindlich gegenüber Qualitätsverlusten und erreichen den Verbraucher oft nicht in der von ihm gewünschten Qualität. Die Zielstellung des Projekts besteht darin, frischeerhaltende Maßnahmen entlang der gesamten Vermarktungskette zu optimieren, sodass sich regionales Ökogemüse (Kopfsalat, Brokkoli, Salatgurke, Möhre und Speisekartoffel) beim Verbraucher durch einen wahrnehmbaren Mehrwert in der erlebten Frische positioniert. Dazu werden Messreihen, die Temperaturaufzeichnungen sowie zeitliche und örtliche Zuordnungen der einzelnen Prozessabschnitte enthalten, mit ausgewählten Kulturen während der Distribution durchgeführt. Außerdem werden auch Wasserverluste kontrolliert. Über die Ermittlung der Temperatursummen und der Transpirationsraten werden Schwachstellen in den einzelnen Vermarktungsabschnitten identifiziert und Verbesserungen zur Qualitätserhaltung erarbeitet

The prevalence of head and face pain decreased from 1997 to 2017 in Switzerland

Background: Pain in the head and the face is highly prevalent but may have changed during the past years. This study aimed to analyze changes in the prevalence of pain in the head and the face in Switzerland from 1997 to 2017. Methods: This is a secondary analysis of data collected in the Swiss Health Surveys of 1997–2017. Included persons were 15 years and older. Besides studying demographic data, we analyze the item assessing the presence of “headache, pressure in the head, or facial pain” during the past 4 weeks. Percentages with their Wilson confidence intervals are reported for each response option of categorical variables. Moreover, we calculate the age‐standardized number of persons affected by the pain. Results: While 41% reported head and face pain in 1997, the proportion dropped to 31% in 2017. There was a decrease of 19.5% in women and 29.4% in men; after age standardization, the decrease was 16.5% in women and 25.4% in men. The most considerable numerical changes in the percentages of women with pain occurred in those aged 55–69 and 85 and above. In men, the changes were not limited to specific age groups. Conclusions: The proportion of people reporting headaches, pressure in the head, or facial pain has dropped in Switzerland from 1997 to 2017. However, in women, the prevalence diminished more strongly and consistently in the middle‐aged and the elderly than in the young

ubiquinone oxidoreductase (complex I) in Escherichia coli

The proton-pumping NADH:ubiquinone oxidoreductase, respiratory complex I, couples the electron transfer from NADH to ubiquinone with the translocation of protons across the membrane. In Escherichia coli the complex is made up of 13 different subunits encoded by the so-called nuo-genes. Mutants, in which each of the nuo-genes was individually disrupted by the insertion of a resistance cartridge were unable to assemble a functional complex I. Each disruption resulted in the loss of complex I-mediated activity and the failure to extract a structurally intact complex. Thus, all nuo-genes are required either for the assembly or the stability of a functional E. coli complex I. The three subunits comprising the soluble NADH dehydrogenase fragment of the complex were detected in the cytoplasm of several nuo-mutants as one distinct band after BN-PAGE. It is discussed that the fully assembled NADH dehydrogenase fragment represents an assembly intermediate of the E. coli complex I. A partially assembled complex I bound to the membrane was detected in the nuoK and nuoL mutants, respectively. Overproduction of the ΔNuoL variant resulted in the accumulation of two populations of a partially assembled complex in the cytoplasmic membranes. Both populations are devoid of NuoL. One population is enzymatically active, while the other is not. The inactive population is missing cluster N2 and is tightly associated with the inducible lysine decarboxylase. This article is part of a Special Issue entitled: Biogenesis/Assembly of Respiratory Enzyme Complexes

CME: Idiopathische intrakranielle Hypertension

Zusammenfassung. Die idiopathische intrakranielle Hypertension ist eine sekundäre Kopfschmerzerkrankung und Optikusneuropathie bei erhöhtem intrakraniellem Druck. Sie betrifft vorwiegend adipöse Frauen im gebärfähigen Alter und stellt sowohl diagnostisch als auch therapeutisch eine interdisziplinäre Herausforderung dar. Häufigstes Symptom dieser Erkrankung sind von Photo- und/oder Phonophobie begleitete Kopfschmerzen, die semiologisch oftmals einer Migräne sehr ähnlich sind, gefolgt von transienten visuellen Obskurationen und pulssynchronem Tinnitus. Während dem Erhalt von Visus und Gesichtsfeld die oberste Therapiepriorität zukommt, spielt auch die adäquate Behandlung der oftmals hartnäckigen und chronischen Kopfschmerzen eine zentrale Rolle. Ein konservatives Vorgehen mittels Gewichtsreduktion und medikamentöser Therapie ist in den meisten Fällen ausreichend. Im Falle fulminanter Verläufe oder relevanter Visuseinschränkung kommen zusätzlich interventionelle Verfahren zum Einsatz. Das Management der Kopfschmerzen richtet sich nach der vorherrschenden Semiologie. CME: Idiopathic Intracranial Hypertension Abstract. Idiopathic intracranial hypertension is a pressure-induced secondary headache disorder and optic neuropathy. It primarily affects obese women of childbearing age and poses an interdisciplinary challenge both diagnostically and therapeutically. The most common symptom of this disorder are headaches frequently accompanied by photo- and/or phonophobia, whose semiology often resembles that of migraine, followed by transient visual obscurations and pulsatile tinnitus. While protection of visual acuity and visual fields are of first therapeutical priority, adequate headache treatment also plays a key role. In the majority of cases, conservative treatment including weight loss and pharmacological therapy is sufficient. In case of a fulminant disease course or loss of visual function, interventional strategies can be applied additionally. Headache treatment is guided by the predominant semiology