Vestibular Migraine

The consensus diagnostic criteria for vestibular migraine (VM) are used to specifically describe episodic vestibular symptoms associated with migraine. Because of an incomplete understanding of the etiology, a variety of clinical manifestations, and overlap with other vestibular disorders, the precise prevalence of VM is unknown. Clinical examination during vestibular episodes and vestibular laboratory tests interictally are more commonly abnormal in patients with VM than in controls, but none of the findings are specific for the diagnosis. The majority of information about VM treatment originates from case studies and retrospective reviews. In this chapter, the current epidemiology data, pathophysiology, significance of clinical and laboratory findings, and possible therapeutic approaches with existing and new medications or devices will be discussed

Risk factors for development of personal protective equipment induced headache : e-survey of medical staff in Baltic states

Funding Information: The authors received no financial support for the research, authorship, and publication of this article. We would like to thank all the medical personnel who participated in this study. Publisher Copyright: © 2022, The Author(s).Background: The COVID-19 pandemic led to an unprecedented increase in the use of personal protective equipment (PPE) among medical personnel. The goal of this study was to determine the risk factors and frequency of PPE-induced headache during the COVID-19 pandemic. Methods: From January 25 to March 1, 2021, an anonymous online survey was undertaken in the Baltic states. Results: In total, 2132 individuals participated. 52.3% experienced a PPE-induced headache. Usual onset time was between 2–3 h, lasting up to 1 h after PPE removal. The most common localization was in temporal and frontal regions. Headache usually occurred 2 to 3 days per week with an average pain score of 5.04 ± 1.80 points. Higher risk was associated with discomfort/pressure OR = 11.55, heat stress OR = 2.228, skin conditions OR = 1.784, long PPE use (duration 10-12 h) OR = 2,18, headache history prior PPE use OR = 1.207. Out of 52.3% respondents with PPE-induced headache, 45.5% developed de novo headache, whereas 54.5% had headache history. Statistically significant differences of PPE-induced headache between respective groups included severity (4.73 vs 5.29), duration (≥ 6 h 6.7% vs 8.2%), accompanying symptoms (nausea (19.3% vs 25.7%), photophobia (19.1% vs 25.7%), phonophobia (15.8% vs 23.5%), osmophobia (5.3% vs 12.0%)) and painkiller use (43.0% vs 61.7%). Conclusions: Over half of the medical personnel reported headache while using PPE. The risk was higher in individuals with headache history, increased duration of PPE use and discomfort while using PPE. Predisposed individuals reported PPE-induced headache which persisted longer, was more intense and debilitating than in the respondents with de novo headache.publishersversionPeer reviewe

Migraine consultation and treatment in the era of COVID-19

During the COVID-19 pandemic, patients have limited access to scheduled visits and emergency departments; these limitations compromise the optimal care of migraine. This article reviews teleconsultation options, patient preparation for counselling, safe use of acute and preventive medications, and treatment strategies for typical and severe migraine attacks. The literature review also provides information on the headache associated with personal protective equipment

De novo migrenos su aura pasireiškimas trečiajame nėštumo trimestre: klinikinis atvejis ir literatūros apžvalga.

Background: Among all headache disorders, migraine has the highest prevalence during gestation. The majority of migraineurs experience improvement during pregnancy, but a few may experience migraine for the first time. This poses a diagnostic challenge in the differential diagnosis between primary and life-threatening secondary headache disorders. Because pregnancy itself is an independent risk factor for secondary headache disorders, it is mandatory to exclude these conditions in order to diagnose migraine. There is a large body of literature about pre-existing migraine course during pregnancy and its link with adverse pregnancy outcomes, but there are no studies examining these aspects among women with new-onset migraine during pregnancy. Case report. A 31-year-old female at 33 weeks of gestation (gravida 2, para 2) was referred to the neurologist eds disturbances, which were followed by pressing severe headache, rated as 8 out of 10 on a numeric rating scale and accompanied by dizziness. The headache lasted for one day, and dizziness continued to the following day. The patient was investigated for a secondary headache disorder, but laboratory and neuroimaging results were unremarkable. A migraine with aura was diagnosed. The patient was advised to keep a consistent sleep schedule, maintain regular low physical activity, eat regularly and take magnesium supplementation. The patient was informed about a safe treatment approach in case of an acute attack. At 40 weeks of gestation the patient delivered female newborn, weighing 3750g, with Apgar scores of 8 and 9 (due to a nuchal cord). The postpartum period was uneventful. During the subsequent 4 years, the patient did not experience any recurrent migraine attacks and had no pregnancies. Conclusion. In order to diagnose a migraine during pregnancy, exclusion of secondary headache disorders is mandatory. Pregnant migraineur should be regularly monitored for adverse birth outcomes. It is essential to educate patients, provide information about the safe treatment of migraine attacks, and explain nonpharmacological prevention and supplementation benefits

New specific migraine prevention: monoclonal antibodies against calcitonin gene-related peptide and its recepto

Migraine is a long-lasting neurological disorder with significant negative impact not only on the patient’s life, but also on society. For many years, preventive treatment of migraine included drugs developed for diseases other than migraine such as hypertension, depression, and epilepsy. During the last decade, blocking calcitonin gene-related peptide (CGRP) has emerged as a possible mechanism for preventing migraine attacks, and monoclonal antibodies against CGRP and its receptor for the specific migraine prophylaxis have been developed. Results of clinical trials, safety and tolerability of the new class of drugs as well as guidelines for their use for the prevention of migraine are presented in this review article

The diagnosis and treatment of migraine among medical students in 2010–2011 and 2019

Background. Migraine prevalence in Lithuania is 18.8%. The aim of this study was to evaluate the prevalence of migraine, quality of life, professionally confirmed diagnosis rate, and treatment among medical students (aged 18-28 years) in 2010-11 and in 2019. Materials and methods. 478 Vilnius university medicine and odontology students participated in the anonymous survey. 252 students were queried in 2010-11 study (aged 23.0±7.8) and 226 in 2019 (aged 23.0±1.5). Questionnaire consisted of questions, based on headache characteristics, triggers, impact on life, presence of confirmed diagnosis, and treatment. The data was analyzed by SPSS 23.0 software, a p value of <0.05 was considered significant. Results. Based on questionnaire, prevalence of migraine with and without aura remained stable between the periods of 2010-11 (27.8%) and 2019 (27.9%) (p=0.98); women were affected more often (p=0.02). Pain remained moderately intense (p=0.07), but migraine disability worsened over the time (p=0.01). Migraine was professionally diagnosed more often in 2019 (10% vs. 25.4%, p=0.03); increased use of specific acute therapy (5.7% vs. 19%, p=0.03) and prophylaxis (0% vs 9.6%, p=0.003) was observed. Likelihood of diagnosis significantly increased with more intense pain (OR=2.7, p=0.006) and aura (OR=2.7, p=0.037). Presence of confirmed diagnosis was an independent determinant of increased triptans (OR=6.9, p=0.012) and prophylaxis (OR=30.3, p=0.036) use. Conclusions. Comparing the 2010-11 and 2019 periods, migraine prevalence is similar. Pain remains to be valued as moderate, but quality of life has worsened. Prevalence of professionally diagnosed migraine has increased over the time, what was accompanied by an increased use of triptans and prophylaxis, however, migraine still remains underdiagnosed and undertreated

Diagnosis and treatment choices of suspected benign paroxysmal positional vertigo: current approach of general practitioners, neurologists, and ENT physicians

PURPOSE: Benign paroxysmal positional vertigo (BPPV) is a frequently underdiagnosed cause of vertigo, potentially due to the underuse of diagnostic and therapeutic canalith repositioning procedures (CRPs). We aimed to investigate self-reported use of the diagnostic and therapeutic approach to BPPV patients by Lithuanian neurologists, ear, nose, and throat (ENT) physicians, and general practitioners (GPs), and to explore potential reasons for the underuse of the maneuvers. METHODS: Neurologists, ENT physicians, and GPs were invited to complete a written questionnaire focused on diagnostic and therapeutic practices related to BPPV. Between-group differences and associations between responses were analyzed statistically. RESULTS: In total, 97 neurologists, 85 ENT physicians and 142 GPs (21.1%, 26.8%, and 5.7%, respectively, of all corresponding licensed Lithuanian physicians) completed the questionnaire. 24% of neurologists, 33% ENT physicians and 50% GPs do not perform diagnostic maneuvers for patients with suspected BPPV, and 28%, 61%, and 84%, respectively, do not perform CRPs. Years of clinical experience was a negative predictor of CRP performance [OR 0.97 (95% CI 0.95-0.99), p = 0.001]. Frequent reasons for not performing CRPs were time taken for the procedure, fear of provoking symptoms, and lack of knowledge. All physicians frequently ordered additional imaging or consultations for suspected BPPV and reported prescribing a range of medications. CONCLUSIONS: A significant proportion of Lithuanian neurologists, ENT physicians, and GPs do not employ diagnostic maneuvers and CRPs for BPPV patients, contrary to established guidelines. Lack of expertise and time available is a common culprit that leads to unnecessary drug prescribing and investigation

Cryptogenic stroke in young patients and cannabis use: case presentation and literature review

Approximately 10% of ischemic strokes occur in people under the age of 50 – this is called early on set or stroke in young adults. In this patient population, there is an especially high number of cryptogenic strokes, where etiology is not identified or several causes are identified, or their exact meaning is not entirely clear, e. g., patent foramen ovale. One of the possible explanations of the increasing incidence in early onset stroke includes an increasing use of psychoactive substances. Most commonly used psychoactive substance in the world and in Lithuania is cannabis; the consumption of synthetic cannabinoids (spice), which is often considered as harmless in society, is also growing. The first case of focal neurological deficiency associated with cannabis use was published five decades ago. There is a number of hypotheses explaining the effect of cannabis and synthetic cannabinoids use on the etiology of stroke, but their proof is difficult. In this article we present a case of cryptogenic stroke in a young patient and review literature on the relationship between the use of cannabis and synthetic cannabinoids and stroke

Skin autofluorescence in systemic sclerosis is related to the disease and vascular damage: a cross-sectional analytic study of comparative groups

Skin autofluorescence (AF), a relatively simple and time saving procedure, measures the accumulation of advanced glycation end (AGE) products. The importance in autoimmune rheumatic diseases, particularly, systemic sclerosis (SSc), has not been evaluated yet. The aim of our study was to examine the skin AF in the context of SSc patients and to analyse the relations between skin AF and other surrogate measures of atherosclerosis. Forty-seven patients with SSc and 47 healthy volunteers were included in this study as controls. Patients and controls underwent common carotid artery wall assessment, arterial stiffness and wave reflection measurements, laser Doppler measurements of capillary flow, assessment of endothelial function by brachial ultrasound, peripheral arterial tonometry, and AGE measurement by skin AF. Wall properties of the common carotid arteries and wave reflection measurements were not affected in these study patients compared to controls while measures reflecting small capillary flow were altered. The accumulation of AGE products measured by skin AF was more prominent in SSc patients than in healthy controls. AGE products’score was significantly associated with carotid radial pulse wave velocity, intima media/carotid artery diameter ratio, capillary flow percentage change during occlusion, and the disease itself in a multivariate linear analysis model