A retrospective cohort study: is COVID-19 BNT162b2 mRNA vaccination a trigger factor for cluster headache?

OBJECTiVE: Cluster headache (CH) is a coronavirus 2019 (COVID-19) vaccination-related adverse event. There are a few case reports of relapses or de novo cluster episodes following the vaccine. The disease's pathophysiology is still not clear. The most widely accepted mechanism is activation of the trigeminocervical complex (TCC). However, the correlation between vaccination and CH is unexplainable. Its goal is to compare the CH bouts of patients before and after the vaccine. METHODS: Patients with a history of CH and who had never experienced COVID-19 illness during the pandemic were included in this retrospective cohort analysis. The semi-structured survey was administered face to face to 24 CH patients (16 male). The headache features before and after vaccination were detailed in this survey. RESULTS: 18 patients got vaccinated twice, and 6 of them had no vaccination. After the first vaccination, 83.3% of them had CH bout; after the second vaccination, 72.2% of them had CH bout. We divided headache episodes into three groups: (1) before vaccination, (2) after the first vaccination, and (3) after the second vaccination. The third group had a higher pain intensity (9.30 ± 0.630, p = 0.047) and remitting longer (20.00 ± 5.40 days, p = 0.019) than the other groups. The management of the 53.3% bouts after vaccinations was less effective than the usual episodes. CONCLUSION: Most ECH patients experienced new bouts more intense and longer duration after vaccinations than their previous bouts, the mechanism, and pathogenesis of the bouts are the subject of future research. The new studies can be a light for understanding the CH pathophysiology more deeply.

The Prevalence, Severity, and Predictive Factors of Restless Legs Syndrome in Pregnancy.

OBJECTIVES:  The current study aimed to search the prevalence and severity of restless legs syndrome (RLS) in pregnancy according to the three trimesters and predictive factors of RLS in pregnancy based on validated diagnostic tools and a thorough literature review. METHODS: The cross-sectional descriptive study included 500 pregnant women without comorbidities who were interviewed face-to-face. Age, height, weight, week of pregnancy, smoking, alcohol, caffeine use, regular exercise, and lab test results from the last visit were all included in the data. Only women satisfying the RLS diagnostic criteria were given the Restless Legs Syndrome Rating Scale. RESULTS: The prevalence of RLS was found to be 29.2% with the highest rate in the third trimester (64.4%). In all trimesters, low ferritin (first trimester: p = 0.004; second trimester: p < 0.001; third trimester: p < 0.001), folic acid (first trimester: p = 0.001; second trimester: p < 0.001; third trimester: p < 0.001), vitamin B12 (first trimester: p = 0.003; second trimester: p < 0.001; third trimester: p < 0.001), and hemoglobin (first trimester: p < 0.001; second trimester: p < 0.001; third trimester: p < 0.001) levels were associated with RLS. In the second and third trimesters, low magnesium (p < 0.001 and p < 0.001, respectively) and high creatinine (p = 0.027 and p < 0.001, respectively) levels were associated with RLS. Higher thyroid-stimulating hormone and free T4 levels were associated with RLS in the third trimester but not in the first and second trimesters (median: 2.4 vs. 2.1, p < 0.001; median: 1.5 vs. 1.2, p < 0.001). In the multivariate regression analysis, age (p = 0.034, OR: 1.060, 95% CI: 1.005-1.119), present BMI (p < 0.001, OR: 1.8884, 95% CI: 1.597-2.222), BMI before conception (p < 0.001, OR: 0.607, 95% CI: 0.513-0.718), gravida (p < 0.001, OR: 2.172, 95% CI: 1.547-3.049), low ferritin level (p < 0.001, OR: 6.396, 95% CI: 0.00744-0.010405), low vitamin B12 (p < 0.001, OR: 10.347, 95% CI: 0.00120-0.00176), low folate (p < 0.001, OR: 5.841, 95% CI: 0.00616-0.01240), RLS history before conception (p = 0.013, OR: 4.963, 95% CI: 1.402-17.57), and RLS family history (p < 0.001, OR: 7.914, 95% CI: 0.18760-0.31151) were found to be predictive factors for RLS in pregnancy. CONCLUSION: More attention is needed to RLS during pregnancy to prevent or treat this syndrome.

Pain-Related Cognitive Processes, Pain Interference, and Alexithymia in Patients With Primary Headaches.

Objectives This study aims to investigate the effects of pain-related cognitive processes (PRCPs) and emotional state on pain-related disability (PRD) and pain interference (difficulty in performing daily routines, difficulty in engaging in social activities [the enjoyment of life], and the impact on work and/or school performance) in patients with primary headaches (PHs). Methodology PRCPs were evaluated with the Pain Anxiety Symptom Scale-20 (PASS-20), Pain Catastrophizing Scale (PCS), and Pain Belief Questionnaire (PBQ). Anxiety, depression, and alexithymia were investigated to assess the emotional state. PRD was assessed by Headache Impact Test-6 (HIT-6). Health-related quality of life (HRQoL) was evaluated under three headings: daily activities (with Short Form-36 [SF-36] Question [Q] 22), social activities (with Graded Chronic Pain Scale-Revised [GCPS-R] Q 4), as well as the working ability (with GCPS-R Q 5). Two separate models were constructed to identify the factors influencing PRD and HRQoL in PHP: M1 to reveal the factors affecting PRD and M2 to determine the independent factors affecting pain interference. In both models, correlation analysis was applied first and the significant data were then evaluated with regression analysis. Results A total of 364 participants (74 healthy controls [HCs] and 290 PHPs) completed the study. In M1, the following domains were significantly associated with PRD: cognitive anxiety (ß = 0.098; 95% confidence interval [CI] = 0.001-0.405; P = 0.049); helplessness (ß = 0.107; 95% CI = 0.018-0.356; P = 0.031); alexithymia (ß = 0.077; 95% CI = 0.005-0.116; P = 0.033); depression (ß = 0.083; 95% CI = 0.014-0.011; P = 0.025). In M2, factors associated with impairment in daily activities for PHP were as follows: duration of pain, pain intensity, alexithymia, escape-avoidance response, psychological anxiety, anxiety, and poor sleep quality (R = 0.770; R2 = 0.588). The independent factors affecting social activities for PHP were pain intensity and pain-related anxiety (R = 0.90; R2 = 0.81). Independent risk factors that affected the ability to work for PHP were pain intensity, cognitive anxiety, escape-avoidance response, and pain anxiety (R = 0.90; R2 = 0.81). Conclusions This study highlights the importance of cognitive and emotional processes that help increase our understanding of the patient with PHs. This understanding may help to reduce disability and improve the quality of life in this population by helping to guide multidisciplinary treatment goals.

Validation, reliability, and cross-cultural adaptation study of Graded Chronic Pain Scale Revised into Turkish in patients with primary low back pain.

OBJECTIVE: This study aims to assess the adaptation of the Graded Chronic Pain Scale-Revised to the Turkish language and psychometric properties in patients with primary low back pain. METHODS: The translation from the original text into the Turkish language was carried out step by step in accordance with the recommendations. Structural validity was analyzed by exploratory factor analysis (EFA). Reliability was carried out by internal consistency and test-retest analysis. Convergent validity was evaluated through scales composed in accordance with the research standards for chronic low back pain with the National Institutes of Health Task Force recommendations. RESULTS: One hundred thirty-five patients, 58 (43%) men and 77 (57%) women, completed the study. A two-factor structure was obtained according to EFA. The first factor consisted of questions 3, 4, and 5, and the same questions constitute the Pain, Enjoyment of Life, and General Activity scale. Cronbach α coefficient r = 0.814 (good internal consistency) was calculated for internal consistency. CONCLUSION: In this article, we presented the cross-cultural adaptation process of Graded Chronic Pain Scale-Revised to the Turkish language and evidence of its validity and reliability in a sample of patients with primary low back pain.

[The effect of steroid injection treatment with carpal tunnel syndrome on sleep hygiene]. / Karpal tünel sendromu tedavisinde steroid enjeksiyonun uyku hijyeni üzerindeki etkisi.

OBJECTIVES: Carpal tunnel syndrome (CTS) is the most seen entrapment neuropathy. CTS is a complex syndrome arisen with entrapment of median nerve at wrist. Pain worst at night, paresthesia, hypoesthesia, paralysis, and muscle atrophy can be seen through nerve entrapment level. Besides, we see negative symptoms for sleep in our practice. It is known the effect of invasive and non-invasive treatments on the sleep. We aimed to search the effect of treatment of CTS on the sleep modalities. METHODS: In our study, the effect of injection treatment of CTS patients diagnosed clinically with electrophysiological methods in neurology clinic, on sleep modalities. After excluding the secondary reasons of CTS; patients responded to visual analog scale (VAS), symptom, and functional scales of Boston questionnaire (BQ-FS), Leeds Assessment of Neuropathic Symptoms and Signs, Pittsburg sleep quality index (PSQI), insomnia severity index (ISI), sleep hygiene index (SHI), Epworth sleepiness scale, Beck depression scale, and Beck anxiety scale. RESULTS: Twenty-nine patients (2 males and 27 females) were enrolled. After treatment, VAS, BQ-FS, LANNS, PSQI, ISI, and SHI both resulted in a significant reduction. CONCLUSION: Sleep hygiene is affected negatively in CTS patients. A healing effect is observed on the quality of sleep impaired by the injection treatment of CTS.