ABSTRACT
Background@#Headache is a common disorder among population. 47% of population of the world suffers from the primary headache. Due to the chronic lasting process of headaches, individuals lose productivity, get depression because of negative impact on people’s quality of life and economic status. </br> Headache disorders are amongst the top ten causes of disability in Europe [4]. Three of these (migraine, tension-type headache and medication-overuse headache) are important in primary care because they are common and responsible for almost all headache-related burden. </br> The burden is immense on workers, women and children in terms of missing work and school days. The personal and social burden of primary headache is high. Health, occupational, social, and psychological factors contributing to burden in people with disabling headache have not been fully unraveled. Headache disorders are not perceived by the public as serious since they are mostly episodic, do not cause death, and are not contagious. A large number of people with headache disorders are not diagnosed and treated: worldwide only 40% of those with migraine or tension-type headache (TTH) are professionally diagnosed and only 10% of those with medication-overuse headache (MOH).</br> There are no studies on the burden and disability assessment in patients with primary headache in our country, therefore a need for conducting this study.@*Goal@#The burden and disability assessment in patients with primary headache in Mongolian adults. @*Methods and Materials@#This cross-sectional study was carried out from June to November of 2017. Participants aged 18-65 years old randomly were selected from four aimags of Mongolia and three districts of Ulaanbaatar city. They were visited by door to door calling and surveyed using the HARDSHIP and Migraine Disability Assessment (MIDAS) questionnaire. The diagnosis of headache was made using the International Classification of Headache Disorders-3 beta. Statistical analysis was performed on SPSS-23 program, and level of depression in headache present patients was determined by odds ratio (OR). Study methodology introduced at Ethical review Committee of “Ach” Medical University and approved in 2017 (№17/3/2).@*Results@#There were 2043 participants 39.7% and 60.3% of them were men and women respectively. The mean age of them was 38.0±13.4 years. 57.4% (n=1173) of participants had headache, and 27.4%, 30.0%, 11.2% and 7.5% of them had migraine, tension-type headache, chronic headache and medication overuse headache respectively. 42% of participants with headache had the median duration of suffering 7 years (IQR=3-13 years). Out of 1173 participants with headache 20.7% had depression. 23% of participants with migraine had depression whereas 68.2 % and 47% of participants with chronic headache and medicine overuse headache had depression respectively. Participants with migraine were 1.85 (OR: 1.85, CI: 95%, 1.39-2.47) times, with chronic headache 3.40 (OR: 3.40, CI: 95%, 2.04-5.67) times and medicine overuse headache 3.31 (OR: 3.31, CI: 95%, 1,50-7.30) times more likely to suffer from depression compare to participants with no headache. </br> People with migraine loses their productivity 10.6 days/m, with chronic headache 19.7 days/m, with MOH 20.3 days/ m. According the MIDAS (migraine disability assessment) people with migraine has mild disability, while people with chronic headache and MOH had middle score of disability. @*Conclusion@#The prevalence of primary headaches is high among Mongolian adults. These headaches cause disability, impair work, study and daily activities, decrease life quality, and brings unrecognized socioeconomic burden.
ABSTRACT
Background@#The primary headache disorders are one of the most common complaints among children and adolescents. Migraine and tension-type headache (TTH) are the most frequently types of primary headache, with prevalence of approximately 9.1% for migraine and 10–24% for TTH among children. </br>The aim of this study was to determine the 1-year prevalence and some risk factors of primary headache disorders in school-aged children.@*Material and Methods@# A cross-sectional, school-based survey consisting of semi-structured questionnaires was administered to randomly select aged 6-11 years using stratified multistage cluster sampling during the period from April to June 2018. The questionnaire of primary headache was based on International Classification of Headache Disorders-III criteria. Statistical analysis was performed by using the SPSS, version 21. Student’s T-test, chi-square test and analysis of variance were used for comparisons when appropriate. The level of statistical significance was set at p<0.05.@*Results@#We surveyed totally 635 participants; the one-year prevalence of all types of headache was 54.6%. Prevalence of migraine and tension-type headache was 3.0% and 5.4%, respectively. Elucidated biometric and socio-demographic risk factors showed statistically significant difference in prevalence of migraine: type of household, life situation and residential quarter.@*Conclusion @#Our study found that frequency of prevalence of primary headaches among the school-aged children is relatively high and comparable with other countries.
ABSTRACT
Background@#Headache disorders are most prevalent public-health problem. Worldwide, among the adults 46% suffer from primary headache, where the migraine presents 11% and tension type headache (TTH) presents 25%. Recently, one type of the primary headache, medication overuse headache tends to increase. Nowadays, there is no sufficient study about primary headache in Mongolia. So that, it is necessary to investigate prevalence, clinical type and risk factors of the primary headache.@*Purpose@#To study prevalence and risk factors of primary headache in Mongolia.@*Materials and Methods@#This cross-sectional study was carried out from June to November of 2017. Participants aged 18-65 years old were randomly selected from four provinces and three districts of Ulaanbaatar city. The diagnosis of headache was made using the International Classification of Headache Disorders-3 beta. Statistical analysis was performed on SPSS-23 program.@*Results@#A total of 2043 participants (812 men and 1231 women) were reviewed. The participant’s average age was 38.6±13.4years. 1350 (66.1%) participants reported recurrent headache within the last 1 year. Of the total study population, the prevalence rate of primary headache was 1305 (63.9%). Number of people who suffered from migraine was 494 (24.2%), significantly greater in female than male participants (p=0.0001), with most frequent attacks at age 26-45 years. The risk of migraine associated with sex, education and family history (p=0.001). 592 (29.0%) of participants had TTH, mean age of them was 37.7±5.24, significant high rate in female than men, risk of TTH depends on education and job. The medication overuse headache was diagnosed at 116 (5.7%), 29.4% in men and 70.5% in women with average of 45.6±11.4 and 43±12.7 respectively. Among the participants 38.6% used medications, 28% people had one drug, 8.5% two drugs and 2% used three or more drugs. Use of non-steroid anti-inflammatory drugs (NSAID) made up major percent in headache patients. Increased frequency of medication and multidrug affected to medication overuse headache (p=0.008).@*Conclusion@#More than half of studied population had primary headache. Migraine was in 24.2%, TTH in 29.0% of people, and associated with sex, education and family history. Use of non-steroid anti-inflammatory drugs made up major percent in headache patients.
ABSTRACT
BackgroundEarly detection of minor strokes and their treatment that aim to prevent from complications into severe strokes is a process of secondary prevention. There is a need to extensively use image diagnostics (CT, MRI) because signs are obscure, at times without focal neurological sign but can have special mental or psychological syndromes. The start of minor stroke studies in Mongolia will enable further deepening of these studies in future and give an impetus to identification of theoreticaland practical aspects together with further improvement of diagnostics, treatment and prevention of minor strokes.GoalTo develop and introduce the diagnostic criteria of ischemic and hemorrhagic minor strokes in accordance to the concepts of minor strokes and to treat minor stokes in order to prevent complications into severe strokes.Materials and MethodCurrently there are no globally accepted diagnostic criteria for minor stroke. We support the 1981 WHO criteria of minor strokes as strokes neurological signs of which disappear in relatively short period of time. There is a general notion that it should mean all light forms of stroke other than severe strokes. In cases of neurological signs of a minor stroke, complete recovery and elimination of the symptoms take up to 3 weeks. Most scholars tend to consider ischemic lacunar strokes (arising from occlusion of arteriole vessels deep in the brain and with size of 0.5-20 mm) as minor strokes. We maintained the concept that characteristic features of these strokes are their limited focal areas and the following neurological symptoms: pure motor, pure sensory, light ataxia, etc. We also duly considered a suggestion (D. German, L. G. Koshchug et al, 2008 ) to define minor hemorrhagic strokes as strokes with diameter less than 2 cm and blood volume less than 5 cm3.We identified 60 patients with minor strokes, involved in monitoring using special research template (with a term of at least 1.5years) and involved in pathogenesis treatment. In the treatment, we maintained a principle of differential diagnosis of ischemic stroke symptoms. Specifically, we differentiated the following: signs related to an atherotromb, cardio-embolic, lacunar, hemodynamic, hemorheologic pathogenesis. To verify the diagnoses, we used MRT and CT image tests. We executed paraclinic tests in order to identify risk factors: Doppler-duplex-sonography, brain angiography, blood lipid fraction, ECG, EchoCG, heart Holter, blood hemorheology test, and identified the most affecting factors (hereditary factors, excess weight, smoking etc).Results: Our study identified the following clinical forms: lacunar stroke, non-lacunar minor stroke, and hemorrhagic minor stroke. Among the minor strokes, the lacunar stroke dominates (48%), the nonlacunar stroke is the next (27.7%), and the hemorrhagic was found to be the least common 25%. From among a host of risk factors, arterial hypertension is dominant (86%) either alone or in combination with such other diseases as diabetes, atherosclerosis etc. Diabetes occurrence was 5 cases (8,3%) which is fewer than in some foreign studies.The clinic of minor stroke also varies. The strength and expression of their symptoms compared with those of severe strokes are unique in the following:- Relatively lighter and recover faster as a result of treatment even in acute forms,- Some are without specific clinical signs (“silent stroke”).- Some minor strokes have micro focal signs, for example, “pure motor”, pure sensory, ataxia etc, in other words, the signs are limited.- In cases of lacunar strokes, predominantly deep brain arterioles are damaged.- Whereas in non-lacun strokes, embolic, ateroma, thrombotic mechanisms are predominant suchas distal branches of big artery. - In cases of hemorrhagic minor strokes, arteriopathy distortions occur not only in depth of brain but also in any small lobar vessels of brain.- Focal lesions have some variations by their pathological locations and minor stroke signs.In non-lacunar strokes (25%), the focal damages predominantly occur in branches of large intra/extra cranial arteries. In cases of lacunars strokes, the focal lesion is not in branches of large intracranial vessels, but is predominantly in basal ganglia, deep white matter, thalamus, pons and in area of deep penetrating arterial vessels. However, focal infarcts in cerebella may occur in any form of minor strokes.ConclusionAccording our study there were identified 3 subtypes of minor stroke. The finding is that lacunars and hemorrhagic minor strokes are more likely to give grounds to severe strokes. From this, it can be concluded that there are specific factors in the population of Mongolia to affect the genesis of minor strokes, namely, arterial hypertension which is directly related with these forms of minor strokes. We appropriate the WHO criteria of minor stroke that is neurological signs of a minor stroke, complete recovery and elimination of the symptoms take up to 3 weeks. In treatment of minor stroke, we suggest that minor strokes should be treating by pathogenetic therapy. Namely, antihypertensive therapy for lacunar infarction, anti-aggregation therapy for nonlacunar infarction and haemostatic and antihypertensive therapy for hemorrhagic minor stroke.
ABSTRACT
In this published case of a male patient B., 53, has some epidemiological specifics. There is transient ischemic attack (TIA) syndrome, particularly while with clear mind there is sudden temporary paralysis of left leg and arm and loss of ability to speak. Temporary refers here to a period of 2-3 minutes after which everything gets back to normal. The incidence occurred again in two days during the medical treatment.MRA test concluded on the presence of obvious stenosis at the beginning part of both sides of a.cerebri media. The mentioned blood vessel pictures were undefined. Hence selected catheter angiography has been done with a purpose to establish the presence of a full occlusion or clogging stenosis in a.cerebri media and to clarify which specific vessels are being mobilized for the collateral supply. This test established that the a.cerebri media had full occlusion on both sides.A duplex sonography conducted in order to clarify characteristics of the clogging (blocking) process concluded the presence of gradual thickening of and blocking in intima (inner wall) of a. carotis interna. Based on these tests we considered that despite the atherosclerosis symptoms (Ischemia in ECG, 20 years of smoking,being male and aged 53, etc), this case had conditions of gradual (slow progressing) arteriopathy. Thus because of the presence in this case simultaneous arteriopathy process (gradually progressing and causing the blocking) in addition to atherosclerosis syndromes we consider it as a Moya-Moya syndrome. The disease of Moya-Moya is mostly found in children and youth and is a unique arteriopathy considered unrelated with atherosclerosis.