BACKGROUND: An increasing amount of evidence suggests that migraine is a response to cerebral energy deficiencies or oxidative stress levels that exceed antioxidant capacity. Current pharmacological options are inadequate in treating patients with chronic migraine, and a growing interest focuses on nutritional approaches as non-pharmacological treatments. The ketogenic diet, mimicking fasting that leads to an elevation of ketone bodies, is a therapeutic intervention targeting cerebral metabolism that has recently shown great promise in the prevention of migraines. Moreover, Mediterranean elements like vegetables, nuts, herbs, spices, and olive oil that are sources of anti-inflammatory elements (omega-3 fatty acids, polyphenols, vitamins, essential minerals, and probiotics) may create a positive brain environment by reducing imbalance in the gut microbiome.
METHODS: On the basis of these indications, a combined Mediterranean-ketogenic diet was administered to chronic migraine patients for 4 (T1) and 8 weeks (T2), and anthropometric estimations were collected at T1 and T2 while biochemical parameters at only T2.
RESULTS: A significant reduction (p < 0.01) in migraine frequency and intensity was detected as early as 4 weeks of dietary intervention, which was associated with a reduced fat mass (p < 0.001) as well as Homa index (p < 0.05) and insulin levels (p < 0.01) after 8 weeks.
CONCLUSIONS: Overall, Mediterranean-ketogenic diet may be considered an effective non-pharmacological intervention for migraine, with positive outcomes on body composition.

Frequent use of pain relief medications among patients with migraine can result in disease worsening and medication-overuse headache (MOH), a painful and debilitating condition. We sought to conduct a cross-sectional survey among adult patients diagnosed with migraine to determine: 1) their awareness of MOH, and 2) their knowledge of the condition and its prevention, and 3) the association of these factors with actual use of pain relief medications. We recruited and interviewed 200 English-speaking adults with migraine who had a clinic visit with a neurologist or primary care provider within the past month. Patients were identified via an electronic health record query. Almost 40% of participants had never heard of the term \'medication-overuse headache.\' In bivariate analyses, participants who were Black or Hispanic and those with limited health literacy were less likely to have heard of MOH. Participants scored an average of 2.1 (range: 0-3) on a MOH knowledge measure; older participants, those with limited health literacy, lower education, and little or no migraine-related disability demonstrated less knowledge. Almost a third (31.5%) of patients reported overusing pain relief medication and were at risk for MOH. Overuse was not significantly associated with MOH awareness, knowledge, or sociodemographic factors, but was related to greater migraine-related disability. Our findings suggest that patient awareness and knowledge of MOH is suboptimal, particularly among older adults, racial and ethnic minority groups, and those with limited health literacy. Interventions are needed to prevent MOH and better inform patients about risks associated with frequent use of pain relief medications.

暂无摘要。

Pituitary apoplexy is a result of rapid enlargement of the pituitary, due to episodes of hyperplasia, which outpaces vascular development resulting in ischemia and potential infarction of pituitary tissue. This can present in several different ways from asymptomatic to hormonal deficiencies. Here we present a case of spontaneous reduction of a non-functioning pituitary mass, likely due to apoplexy, in which the mass went from compromising the optic chiasm to complete reduction and relief of the optic chiasm. The infarction happened spontaneously without treatment and complications. This may encourage future conservative management of pituitary tumors, rather than immediate surgical intervention.

Midwifery centers are places where midwives not only provide antenatal checkups and delivery care but also offer a wide range of health guidance to pregnant women, postpartum mothers, newborns, and older women. In recent years, midwives have also provided onsite and online health guidance. However, diagnosis and prescribing medication are impossible in midwifery centers because no doctor is present. If the midwife determines that the patient should consult doctors, the patient may have to go to a hospital and see doctors in person, which can be burdensome. Online telemedicine facilitates midwife-doctor collaboration and may solve this problem. We report a case of headache management by telemedicine that minimized the patient\'s travel burden by collaborating with a midwifery center that provides onsite, visiting, and online health guidance for patients who have difficulty visiting a hospital due to postpartum period, childcare, and breastfeeding. A 29-year-old woman and her husband were raising an infant in Sado City (a remote island across the sea), Niigata Prefecture. She developed acute back pain and was bedridden for several days due to immobility. She consulted a midwife because of stress and anxiety caused by childcare and acute back pain, as well as newly occurring headaches. The midwife visited her and provided on-site health guidance. The midwife decided that a doctor\'s diagnosis and treatment with painkillers were desirable for the headache and back pain, so she contacted a doctor based on the patient\'s request. The doctor provided online telemedicine across the sea, diagnosed her headache as a tension-type headache, and prescribed acetaminophen 500 mg as an abortive prescription. The prescription was faxed to a pharmacy on the island, and the original was sent by post. The midwife picked up the medication and delivered it to the patient. After taking the medication, the patient\'s back pain and headache went into remission. Collaboration between midwifery centers that provide onsite, visiting, and online health guidance and medical institutions that offer online telemedicine can potentially improve accessibility to medical care. It differs from conventional online telemedicine in the midwife\'s coordination practice by monitoring the patient\'s condition and requesting the physician based on the patient\'s request.

UNASSIGNED: Real-world studies have shown the sustained therapeutic effect and favourable safety profile of OnabotulinumtoxinA (BoNTA) in the long term and up to 4 years of treatment in chronic migraine (CM). This study aims to assess the safety profile and efficacy of BoNTA in CM after 5 years of treatment in a real-life setting.
UNASSIGNED: We performed a retrospective chart review of patients with CM in relation to BoNTA treatment for more than 5 years in 19 Spanish headache clinics. We excluded patients who discontinued treatment due to lack of efficacy or poor tolerability.
UNASSIGNED: 489 patients were included [mean age 49, 82.8% women]. The mean age of onset of migraine was 21.8 years; patients had CM with a mean of 6.4 years (20.8% fulfilled the aura criteria). At baseline, patients reported a mean of 24.7 monthly headache days (MHDs) and 15.7 monthly migraine days (MMDs). In relation to effectiveness, the responder rate was 59.1% and the mean reduction in MMDs was 9.4 days (15.7 to 6.3 days; p < 0.001). The MHDs were also reduced by 14.9 days (24.7 to 9.8 days; p < 0.001). Regarding the side effects, 17.5% experienced neck pain, 17.3% headache, 8.5% eyelid ptosis, 7.5% temporal muscle atrophy and 3.2% trapezius muscle atrophy. Furthermore, after longer-term exposure exceeding 5 years, there were no serious adverse events (AE) or treatment discontinuation because of safety or tolerability issues.
UNASSIGNED: Treatment with BoNTA led to sustained reductions in migraine frequency, even after long-term exposure exceeding 5 years, with no evidence of new safety concerns.

OBJECTIVE: To evaluate the effectiveness of a multidisciplinary program, including Cognitive behavioral therapy (CBT), in the treatment of patients with chronic migraine (CM) and concomitant chronic insomnia (CI).
METHODS: The study included 96 patients with CM and CI, average age 35.7±8.6. All patients underwent clinical interviews and testing using clinical and psychological techniques. Patients were randomized into two groups: group 1 received study treatment (an multudisciplinary program including CBT for pain and insomnia, combined with standard treatment for migraine), group 2 received standard treatment for migraine (preventive and acute pharmacotherapy for migraine, recommendations about lifestyle and sleep hygiene). All patients were assessed for clinical and psychological parameters before treatment and at 3, 6, 12 and 18 months follow-up.
RESULTS: At 3 month follow-up a statistically significant improvement was observed in group 1: a decrease in the frequency of headaches and the use of painkillers, parameters on the Insomnia Severity Index (ITI), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory, and the Migraine Disability Assessment (MIDAS) (p<0.05). At 6, 12 and 18 months follow-up the achieved improvements were maintained. At 3 month follow-up, group 2 showed a statistically significant improvement in only 4 parameters: a decrease in the frequency of headaches and painkiller use, and parameters for ITI and MIDAS. These parameters increased to values that were not statistically significantly different from the parameters before treatment in group 2 at 6 month follow-up. At 3 month follow-up in group 165% of patients achieved clinical effect (CE) according to CM (headache frequency decreased by 50% or more), in group 2 - 40%, which was not statistically significantly different (p>0.001); in group 1, 76% of patients achieved CE according to CI (ITI decreased by 8 points or more), which is statistically significantly more than in group 2 with 45% of patients with CE (p<0.001). At 18 month follow-up, in group 1, 81.5% of patients achieved CE according to CM, which is statistically significantly more than in group 2 with 33% of patients with CE (p<0.001); in group 1, 85% of patients achieved CE according to CI, which is statistically significantly more than in group 2, where 38% of patients had CE (p<0.001).
CONCLUSIONS: High effectiveness of CBT in patients with CM and combined CI was noted.
UNASSIGNED: Оценить эффективность междисциплинарной программы, включающей когнитивно-поведенческую терапию (КПТ), в лечении пациентов с хронической мигренью (ХМ) и сочетанной хронической инсомнией (ХИ).
UNASSIGNED: В исследование включены 96 пациентов с ХМ и ХИ, средний возраст 35,7±8,6 года. Со всеми пациентами проводились клиническая беседа и тестирование с помощью клинико-психологических методик. Пациенты были рандомизированы в две группы: 1-я группа получала стандартное лечение (фармакотерапию профилактическую и для купирования мигрени, рекомендации по образу жизни и гигиене сна) и КПТ, 2-я группа — только стандартное лечение. У всех пациентов оценивались клинико-психологические показатели до лечения и на 3, 6, 12 и 18-й месяцы после лечения.
UNASSIGNED: Через 3 мес терапии в 1-й группе наблюдалось статистически значимое улучшение: снижение частоты приступов головной боли и приема обезболивающих, показателей по Индексу тяжести инсомнии (ИТИ), шкале личностной и ситуативной тревоги Спилбергера—Ханина, шкале депрессии Бека, шкале оценки влияния мигрени на повседневную активность (ШОВМА) (p<0,05). Через 6, 12 и 18 мес терапии достигнутые улучшения сохранились. Через 3 мес терапии во 2-й группе наблюдалось статистически значимое (p<0,05) улучшение только по 4 параметрам: снижение частоты приступов головной боли и приема обезболивающих, показателей по ИТИ и ШОВМА. С 6 мес терапии во 2-й группе эти показатели статистически значимо не отличались от показателей до лечения. Через 3 мес терапии клинического эффекта (КЭ) по ХМ (снижение частоты головной боли на 50% и более) в 1-й группе достигли 65% пациентов, во 2-й группе — 40%; КЭ по ХИ (ИТИ уменьшился на 8 баллов и более) в 1-й группе — 76% пациентов, во 2-й группе — 45% (p<0,001). Через 18 мес терапии КЭ по ХМ в 1-й группе достигли 81,5% пациентов, во 2-й группе — 33% (p<0,001); КЭ по ХИ в 1-й группе — 85% пациентов, во 2-й группе — 38% (p<0,001).
UNASSIGNED: Отмечена высокая эффективность КПТ у пациентов с ХМ и сочетанной ХИ.

OBJECTIVE: To analyze complaints about sleep disorders and assess the incidence of various sleep disorders, using relevant scales, in patients with medication-overuse headache (MOH) in comparison with patients without MOH.
METHODS: The prospective case-control study included 171 patients, aged 18 years and older, with MOH (main group), and173 patients with primary headaches without MOH (control group). A neurologist conducted an initial examination and professional interview before the start of treatment. To diagnose sleep disorders, the International Classification of Sleep Disorders (3rd edition, 2014) was used. Additionally, an assessment was made using the Insomnia Severity Index Scale, the Epworth Sleepiness Scale (ESS) and the Lausanne Obstructive Sleep Apnea Syndrome Scale (NoSAS).
RESULTS: Statistically significant differences were revealed in the prevalence of the following complaints about sleep disorders in patients with MOH: lack of sleep (51.5%), frequent awakenings during sleep (43.3%), discomfort in legs before falling asleep or at rest in the evening (37.4%). Difficulties falling asleep occurred equally often in both patients with MOH (43.9%) and without MOH (37.0%), as well as daytime sleepiness (40.4% vs 36.4%) and the presence of snoring (13% of patients in each group). Patients with MOH were significantly more likely to suffer from chronic insomnia (60.2% and 47.4%, respectively, p=0.02; OR 1.7; 95% CI 1.1-2.6) and restless legs syndrome (37.4% and 22.0%, respectively, p=0.002; OR 2.1; 95% CI 1.3-3.4). The incidence of hypersomnia and obstructive sleep apnea syndrome did not have statistically significant differences.
CONCLUSIONS: Patients with MOH compared to patients without MOH have a significantly higher incidence of main complaints of sleep disorders, chronic insomnia and restless legs syndrome, which indicates the importance of sleep disorders in the pathogenesis of medication-overuse headaches and requires timely diagnosis and treatment to prevent the progression of both headaches and sleep disorders.
UNASSIGNED: Анализ жалоб на нарушения сна и оценка встречаемости различных расстройств сна с использованием шкал у больных с лекарственно-индуцированной головной болью (ЛИГБ) в сравнении с пациентами без ЛИГБ.
UNASSIGNED: В проспективное исследование по типу «случай-контроль» включен 171 пациент в возрасте 18 лет и старше, имеющий ЛИГБ (основная группа), а также 173 пациента с первичными головными болями без ЛИГБ (контрольная группа). Первичный осмотр и профессиональное интервью проведены врачом-неврологом до начала лечения с использованием стандартизированных опросников. Для диагностики нарушений сна использовалась Международная классификация нарушений сна (3-е издание, 2014). Дополнительно произведена оценка по шкалам индекса тяжести инсомнии, Эпвортской шкале дневной сонливости и Лозаннской шкале синдрома обструктивного апноэ сна (NoSAS).
UNASSIGNED: Статистически значимые различия выявлены в превалировании следующих жалоб на нарушения сна у больных с ЛИГБ: невыспанность по утрам (51,5%), частые пробуждения во время сна (43,3%), неприятные ощущения в ногах перед засыпанием или в состоянии покоя в вечернее время (37,4%). Трудности засыпания встречались одинаково часто у больных как с ЛИГБ (43,9%), так и без ЛИГБ (37,0%), так же как дневная сонливость (40,4% против 36,4%) и наличие храпа (13% больных в каждой из групп). Больные с ЛИГБ значительно чаще страдали хронической инсомнией (60,2 и 47,4% соответственно, p=0,02; ОШ 1,7; 95% ДИ 1,1—2,6) и синдромом беспокойных ног (37,4 и 22,0% соответственно, p=0,002; ОШ 2,1; 95% ДИ 1,3—3,4). Встречаемость гиперсомнии, синдрома обструктивного апноэ сна не имели статистически значимых различий.
UNASSIGNED: Больные с ЛИГБ, по сравнению пациентами без ЛИГБ, имеют значительно большую встречаемость основных жалоб на нарушения сна, хронической инсомнии и синдрома беспокойных ног, что указывает на важное значение нарушений сна в патогенезе ЛИГБ и требует своевременной диагностики и лечения для профилактики прогрессирования как головных болей, так и нарушений сна.

暂无摘要。

OBJECTIVE: The aim of the study was to determine the heavy metal and trace element (HMTE) profile in patients with migraine (PwM) and to compare it to that of healthy individuals without migraine.
BACKGROUND: Migraine is a universal disease that affects more than 10% of the world\'s population; however, its pathophysiology is still obscure.
METHODS: A total of 100 participants were included in this prospective matched case-control study (50 PwM during acute attack and 50 age- and sex-matched healthy controls). The study was conducted in the university hospital in Yozgat, Turkey, where the inductively coupled plasma mass spectrometry system was used to measure the HMTE profile. The calibration curve was created with 11 points for heavy metals (arsenic [As], cadmium [Cd], cobalt [Co], lead [Pb], mercury [Hg], nickel [Ni], and tin [Sn]) and trace elements (antimony [Sb], chromium [Cr], copper [Cu], iron [Fe], magnesium [Mg], manganese [Mn], molybdenum [Mo], and zinc [Zn]).
RESULTS: The median age was 27 (23-37) years, and the female/male ratio was 37/13 for both groups. The PwM group had significantly higher As, Co, Pb, and Ni levels among the heavy metals (p = 0.033, 0.017, 0.022, and 0.021, respectively). Also, PwM had significantly lower Cr, Mg, and Zn levels among the trace elements (p = 0.007, 0.024, and < 0.001, respectively). The only trace element that was elevated in the PwM group was Mn (p = 0.001). The PwM and control groups did not differ in terms of Cd, Sn, Sb, Cu, Fe, and Mo (p = 0.165, 0.997, 0.195, 0.408, 0.440, and 0.252, respectively).
CONCLUSIONS: Some HMTE parameters are altered in PwM, which may provide additional insight into understanding migraine etiology.