Impact of trigger factors on clinical profile of migraine patients

Background: Migraine is a primary headache disorder. The study was designed to provide a better understanding of the potential role of triggers in the cause of migraine and their impact on its clinical profile and treatment protocol.Methods: A prospective study was conducted between June 2018 to May 2020 in 323 patients suffering from migraine in out-patient department of neurology. Patients were labelled as migraine on the basis of simplified diagnostic criteria for migraine. A structured questionnaire was used to interview patients about triggers and correlated with various clinical variables.Results: All patients had migraine without aura with males 30 (9.3%) and females 293 (90.7%). Episodic migraine found more than chronic daily headache. Trigger factors were present in 234 (72.4%) and absent in 89 (27.6%) patients. Common triggers were hot climate, emotional stress, lack of sleep and fasting. Common foods to precipitate an attack are tomatoes, cheese and collard greens. Mean duration of headache in patients with trigger factors is 5.67±4.99 years with a significant p value (p<0.02). Mean frequency of headache in trigger positive patients is 15.22±8.28 (days/month). Clinical symptoms significant in trigger positive patients are nausea (p<0.0001) (OR=3.94;95% CI=2.02-7.68),vomiting (p=0.0001) (OR=2.62;95% CI=1.50-4.59), photophobia (p<0.0001) (OR=2.69;95% CI=1.56-4.64), phonophobia (p<0.0001) (OR=5.16; 95% CI=2.54-47), pulsating headache (p=0.006) (OR=2.09; 95% CI=1.22-3.56), unilateral location (p<0.0001) (OR=2.88; 95% CI=1.74-4.77).Conclusions: Triggers are not easily modifiable, and avoiding triggers may not be realistic. Healthy life style like exercise, adequate sleep, stress management and eating regularly may prevent triggers and transformation to chronification over time

Intrauterine Contraceptive Device Migration Presenting as Abdominal Wall Swelling: A Case Report

A number of complications are reported with the use of intrauterine contraceptive devices. These may pursue asymptomatic course or present as an acute abdomen after migration into peritoneal cavity. The authors here are reporting an abdominal wall swelling caused by transuterine migration of a copper intrauterine contraceptive device in a 28-year-old female. An open approach was used, and impacted foreign body was retrieved

Encysted Hydrocele of Cord in an Adult Misdiagnosed as Irreducible Hernia: A Case Report

A 36 year old male was presented with swelling in the right groin for a 12 days duration. For the last 2 days, the patient had severe progressive pain in groin area and low grade fever for which he reported to the emergency services. There was no history of constipation, loose motions or vomiting. General physical examination as well as systemic examination were normal. Abdominal examination was normal, with no organomegaly and normal bowel sounds were present. On local examination, a globular, soft, tender swelling measuring 5×2.3×1 centimeter, with negative cough impulse was present in the right inguinal region Figure 1: Swell in Right Groin Abstract A number of pathologies can present as groin swellings in adults.Among these, encysted hydrocele of the cord presenting as swelling in an adult is a rare. A case of encysted hydrocele of cord in 36 year old male mimicking as as an irreducible hernia is reported. The diagnosis of hydrocele was made intraoperatively. An excision of the sac was performed

SOCIODEMOGRAPHIC AND COMORBIDITY PROFILES OF MIGRAINE PATIENTS: AN OUTPATIENT-BASED STUDY IN A TERTIARY CARE HOSPITAL

Objective: Migraine is a primary headache disorder. The study was undertaken to assess correlation between sociodemographic characteristics of migraineurs with their various comorbidities so as to determine most important factors influencing their comorbidity profile. Methods: A prospective study was conducted between June 2018 –April 2020 in 323 patients suffering from migraine in out-patient department of Neurology. Patients were labeled as migraine on the basis of Simplified Diagnostic Criteria for Migraine. A structured questionnaire was used for evaluation of sociodemographic variables and evidence based approach was adapted to fill psychiatric and comorbidity profiles of patients. Results: In 323 patients of migraine males were 30 (9.3%) and females 293 (90.7%). Mean age of males is 38.80±17.53 years and of females 35.38±13.29 years, (p=0.307). Most of them were in 21-30 years age group followed by 31-40 years Majority of patients were from district Srinagar followed by Ganderbal. Housewives formed major group of patients followed by students It was seen more in the illiterate class than in literates. 57% patients belonged to lower middle class. Psychiatric comorbidities including anxiety,depression and physical comorbidities like hypertension, hypothyroidism and comorbid pains were common associations. Comorbidities have been compared with mean age of the patients and it was found that psychiatric comorbidities, neuropathic pain, hypothyroidism, hypertension, Type 2 DM, comorbid pains and PCOD were statistically significant, (p=≤0.05). Conclusion: Most common comorbidities associated with migraine are anxiety, depression, neuropathic pain, hypothyroidism, hypertension, Type 2 DM and comorbid pain. Comorbidities have direct impact on nature of treatment protocol and need to be addressed to achieve outcome based treatment

Appendiceal ascariasis in children

<b>Background</b> : The propensity of <i>Ascaris lumbricoides</i> to wander leads to varied surgical complications in the abdomen. Wandering <i>A lumbricoides</i> may sometimes reach the vermiform appendix and its presence there may remain silent or incite pathology. Our aim was to study ascariadial appendicitis. <b> Methods</b> : Over a period of 3 years, we identified children who were found to have appendiceal ascariasis during surgery for different intestinal complications due to ascariasis. We studied the relationship between ascariasis and its lodgement inside the vermiform appendix in these patients. No preoperative diagnosis was made in this series. <b> Results</b> : We found 11 patients with appendiceal ascariasis. It was incidentally found that 8/11 (72.7&#x0025;) patients had worms inside their vermiform appendix but not appendicitis, whereas the remaining three patients (27.2&#x0025;) were found to have <i>Ascaris</i>-associated appendicitis. The characteristic finding in <i>Ascaris</i>-infested vermiform appendix was that the worm is positioned with its head at the base and its tail at the tip of the appendix. <b>Conclusion</b> : Migration of <i>A lumbrocoides</i> inside the vermiform appendix is an incidental finding and tends to pursue a silent course in most patients. Only rarely does the presence of <i>Ascaris</i> inside the vermiform appendix cause appendicitis