Identification of Allodynic Migraine Patients with the Turkish Version of the Allodynia Symptom Checklist: Reliability and Consistency Study Allodini Varlığının Migren Hastalarında Allodini Semptom Anketi Tükçe Versiyonu (ASC/T) ile Saptanması: Geçerlilik

Introduction: Cutaneous allodynia is regarded as an expression of central sensitization in migraine. Although the gold standard is quantitative sensory testing, several practical assessment questionnaires have been developed to assess allodynia in migraine. We aimed to establish the first valid Turkish allodynia assessment questionnaire based on a 12-item allodynia symptom checklist and to evaluate the associated factors. Methods: The first part of the study included the translation and cultural adaptation of a Turkish version of the checklist. The Turkish version of the questionnaire was administered to 344 episodic and chronic migraine patients, who were chosen according to the International Classification of Headache Disorders -III beta criteria. Results: The total checklist score showed excellent test-retest reliability (r=0.821). The internal consistency of the checklist was assessed using Cronbach alpha values and was found to be acceptable (Cronbach alpha for the checklist=0.767). Data analysis revealed that 10 items of the questionnaire adequately identified allodynic subjects. Cutaneous allodynia was present in 218 (63.4%) migraine patients. Allodynia was more prominent in patients experiencing migraine with aura (p=0.008) and in females (p<0.001). Multiple logistic regression analysis found that female gender, aura existence, longer headache duration, and higher attack frequency were the major determinants of cutaneous allodynia. Conclusion: Allodynia is common and has clinical significance in migraine; therefore, establishing a validated Turkish questionnaire for the assessment of allodynia was necessary. In this study, a Turkish version of the allodynia symptom checklist was validated and found to be convenient for the identification of allodynia in migraine patients. Keywords: Migraine, cutaneous allodynia, checklist, validity ABSTRACT Amaç: Kutanöz allodini migrende santral sensitizasyonun göstergesi olarak kabul edilmektedir. Altın standart kantitatif duysal test olmasına ragmen, migren hastalarında allodini araştırılması için geliştirilmiş çok sayıda anket bulunmaktadır. Bu çalışmada 12 madde içeren allodini semptom anketinin (ASC) Türkçeye uyarlanması ile ilk Türkçe geçerliliği gösterilmiş anketin geliştirilmesi ve ilişkili faktörlerin araştırılması amaçlandı. Yöntem: Çalışmanın birinci aşaması anketin Türkçe'ye çevirisi ve kültürel adaptasyonunu içermektedir. İkinci aşamada, geliştirilen Türkçe anket Uluslarası Başağrısı Cemiyeti Başağrısı Sınıflandırması-3 beta (ICHD-3 beta)'ya göre tanı almış 344 epizodik ve kronik migren hastasına uygulandı. Bulgular: Toplam anket skoru test-tekrar test değerlendirmesinde mü-kemmel güvenilirlik gösterdi (r=0,821). Anketin içsel tutarlılığı Kronbach Alfa Değeri ile değerlendirildi ve kabul edilebilir tutarlılık gösterdi (Anket Kronbach Alfa değeri: 0,767). Veri analizleri ankette bulunan 10 maddenin allodinik bireylerin tespit edilmesinde yeterli olduğunu gösterdi. Kutanöz allodini 218 migren hastasında (%63,4) saptandı. Allodini auralı migren hastalarında (p=0,008) ve kadınlarda daha sıktı (p<0,001). Çok-lu lojistik regresyon analizinde kadın cinsiyet, aura varlığı, uzun başağrısı süresi ve sık atak sayısının kutanöz allodini varlığının başlıca belirleyicileri olduğu gösterildi. Sonuç: Allodininin migrende sık görülmesi ve klinik açıdan önemli olması nedeniyle geçerliliği gösterilmiş bir Türkçe allodini anketi bulunmasının gerekli olduğunu düşünmekteyiz. Bu çalışmada ASC-Türkçe versiyonunun geçerliliği ve migren hastalarında allodinin saptanmasında uygun bir anket olduğu gösterilmiştir

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Peripheral nerve blocks for the treatment of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) during pregnancy

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a rare, primary headache syndrome, which is classified as a subtype of trigeminal autonomic cephalalgias. Although SUNCT is usually refractory to treatment, several antiepileptic drugs have recently shown promising results for its treatment. However, there is a lack of evidence regarding the course of SUNCT during pregnancy and the available treatment options. Here, we present a 30-week pregnant female with SUNCT who was successfully treated with infra- and supraorbital nerve blocks. Headache attacks completely diminished after the injection, and recurrence was not observed. Although lamotrigine may be relatively safe in pregnant patients with SUNCT attacks, peripheral nerve block may be a feasible technique and can be considered as a safe and effective treatment option. This is the first SUNCT case in the literature that was successfully treated with infra- and supraorbital nerve blocks during pregnancy

What is the impact of having a family history of migraine on migraine characteristics?

Objectives: There are only a handful of studies examining the clinical differences between patients with and without a family history of migraine. Our aim is to compare the descriptive and clinical properties of patients with and without a family history, and to investigate the association between the migraine burden and disease characteristics and disability of migraine

Migraine and cardiovascular risk factors: A clinic-based study

Objective: The relation between migraine and vascular risk factors is an unclear issue. Furthermore, the reasons for chronification are still unknown. Probably, the age-related risk and other factors leading to migraine progression will also change in the future. Under these questions, we aimed to investigate whether or not there is a specific association with vascular risk factors between several age groups and subtypes of migraine and also in their families

Assessment of the Utility of the Septal E/(E′×S′) Ratio and Tissue Doppler Index in Predicting Left Ventricular Remodeling after Acute Myocardial Infarction

Background. The aim of this study is to show whether the septal E/(E′×S′) ratio assessed by tissue Doppler echocardiography can predict left ventricular remodeling after first ST segment elevation myocardial infarction treated successfully with primary percutaneous intervention. Methods. Consecutive patients (n=111) presenting with acute anterior myocardial infarction for the first time in their life were enrolled. All patients underwent successful primary percutaneous coronary intervention. Standard and tissue Doppler echocardiography were performed in the first 24-36 hours of admission. Echocardiographic examination was repeated after 6 months to reassess left ventricular volumes. Septal E/(E′×S′) ratio was assessed by pulsed Doppler echocardiography. Results. Group 1 consisted of 33 patients with left ventricular (LV) remodeling, and Group 2 had 78 patients without LV remodeling. E/(E′×S′) was significantly higher in Group 1 (4.1±1.9 versus 1.65±1.32, p=0.001). The optimal cutoff value for E/(E′×S′) ratio was 2.34 with 87.0% sensitivity and 82.1% specificity. Conclusion. Septal E/(E′×S′) values measured after the acute anterior myocardial infarction can strongly predict LV remodeling in the 6-month follow-up. In the risk assessment, the septal E/(E′×S′) can be evaluated together with the conventional echocardiographic techniques

Assessment of the Utility of the Septal E/(E′×S′) Ratio and Tissue Doppler Index in Predicting Left Ventricular Remodeling after Acute Myocardial Infarction

Background. The aim of this study is to show whether the septal E/(E′×S′) ratio assessed by tissue Doppler echocardiography can predict left ventricular remodeling after first ST segment elevation myocardial infarction treated successfully with primary percutaneous intervention. Methods. Consecutive patients (n=111) presenting with acute anterior myocardial infarction for the first time in their life were enrolled. All patients underwent successful primary percutaneous coronary intervention. Standard and tissue Doppler echocardiography were performed in the first 24-36 hours of admission. Echocardiographic examination was repeated after 6 months to reassess left ventricular volumes. Septal E/(E′×S′) ratio was assessed by pulsed Doppler echocardiography. Results. Group 1 consisted of 33 patients with left ventricular (LV) remodeling, and Group 2 had 78 patients without LV remodeling. E/(E′×S′) was significantly higher in Group 1 (4.1±1.9 versus 1.65±1.32, p=0.001). The optimal cutoff value for E/(E′×S′) ratio was 2.34 with 87.0% sensitivity and 82.1% specificity. Conclusion. Septal E/(E′×S′) values measured after the acute anterior myocardial infarction can strongly predict LV remodeling in the 6-month follow-up. In the risk assessment, the septal E/(E′×S′) can be evaluated together with the conventional echocardiographic techniques