Eating attitudes of migraine patients in Turkey: a prospective multi-center study.

BACKGROUND: Migraine is a disease characterized by headache attacks. The disease is multifactorial in etiology and genetic and environmental factors play role in pathogenesis. Migraine can also be accompanied by psychiatric disorders like neurotism and obsessive compulsive disorder. Stress, hormonal changes and certain food intake can trigger attacks in migraine. Previous studies showed that eating attitudes and disorders are prevalant in patients with migraine. Eating disorders are psychiatric disorders related to abnormal eating habits. Both migraine and eating disorders are common in young women and personality profiles of these patient groups are also similar. A possible relationship which shows that migraine and eating habits are related can lead to a better understanding of disease pathogenesis and subsequently new therapeutic options on both entities. Association of migraine in relation to severity, depression and anxiety and eating habits and disorders were aimed to be investigated in this study. METHODS: The study was designed as a prospective, multi-center, case control study. Twenty-one centers from Turkey was involved in the study. The gathered data was collected and evaluated at a single designated center. From a pool of 1200 migraine patients and 958 healthy control group, two groups as patient group and study group was created with PS matching method in relation to age, body-mass index, marital status and employment status. Eating Attitudes Test-26 (EAT-26), Beck's Depression Inventory (BDI) and Beck's Anxiety Inventory (BAI) were applied to both study groups. The data gathered was compared between two groups. RESULTS: EAT-26 scores and the requirement for referral to a psychiatrist due to symptoms related to eating disorder were both statistically significantly higher in patient group compared to control group (p = 0.034 and p = 0.0001 respectively). Patients with migraine had higher scores in both BDI and BAI compared to control group (p = 0.0001 and p = 0.0001 respectively). Severity of pain or frequency of attacks were not found to be related to eating attitudes (r:0.09, p = 0.055). CONCLUSIONS: Migraine patients were found to have higher EAT-26, BDI and BAI scores along with a higher rate of referral to a psychiatrist due to symptoms. Results of the study showed that eating habits are altered in migraine patients with higher risk of eating disorders. Depression and anxiety are also found to be common amongst migraine patients.

Comparison of clinical features in patients with vestibular migraine and migraine.

Vestibular migraine (VM) is accepted as the most common cause of spontaneous episodic vertigo. In most patients, vestibular symptoms follow migraine headaches that begin earlier in life. The aim of this multicenter retrospective study was to find out the differences between migraine patients without any vestibular symptoms (MwoV) and VM patients and to delineate the specific clinical features associated with VM. MwoV and VM patients were compared regarding demographic features, migraine headache years, headache attack frequency, intensity, symptoms associated with headache and vertigo attacks, presence of menopause, history of motion sickness and family history of migraine. Four-hundred and forty patients with MwoV and 408 patients with VM were included in the study. Migraine with aura was more frequent in patients with MwoV (p = 0.035). Migraine headache years was longer (p < 0.001) and headache intensity was higher in patients with VM (p = 0.020). Aural fullness/tinnitus was more common in patients with VM (p < 0.001) when all other associated symptoms were more frequent in patients with MwoV (p < 0.001) as well as attack triggers (p < 0.05). Presence of menopause and motion sickness history was reported more frequently by VM patients (p < 0.001). Logistic regression analysis indicated that longstanding history of migraine with severe headache attacks, aural fullness/tinnitus accompanying attacks, presence of menopause, previous motion sickness history were the differentiating clinical features of patients with VM.

Prognostic indicators of non-convulsive status epilepticus in intensive care unit.

BACKGROUND: To determine the rate of non-convulsive status epilepticus with/without prominent motor phenomena (SE-PM/ NCSE) and predictive value of electroclinical findings of continious electroencephalography (cEEG) monitoring of these patients and its association with prognosis in intensive care units (ICU). METHODS: We retrospectively collected data of 218 patients whose cEEG was performed in ICU between 2016 and 2018. The cEEG for NCSE diagnosis was evaluated according to Salzburg Consensus Criteria (SCC). RESULTS: The mean age of patients was 57.09 ± 18.9 (16-95) years and 49.1% (107) were female. Of 218 patients, 32 (14.7%) had SE-PM/NCSE. According to SCC the rate of NCSE (NCSE + possible NCSE) was 9.6% (n = 21). Prior to cEEG recording, 38.9% (n = 85) of overall patients had a history of seizure/convulsion, and 22.7% (n = 21) of these patients diagnosed with NCSE based on cEEG. The mortality rates in critically ill patients were 41.3% (30.8%, 42.8%; for SE-PM and NCSE respectively). Prognosis was associated with age, epilepsy diagnosis, having convulsion/seizure history on follow-up, GCS, need for ventilation, kind of drugs, sepsis diagnosis, and minimum frequency of background activity of the cEEG (p = 0.001, 0.002, 0.001, 0.020, 0.001, 0.001, 0.001, 0.0001 respectively). CONCLUSIONS: NCSE findings are mostly found in patients who were comatose and had seizure/convulsion history on follow-up. Mortality is higher in patients diagnosed with NCSE followed in the ICU compared to SE-PM.

Capecitabine-related neurotoxicity presenting with agraphia.

INTRODUCTION: Capecitabine is a pre-metabolite of 5-fluorouracil and is used as a chemotherapeutic agent. Among the common side effects of capecitabine, there are gastrointestinal side effects including nausea, vomiting, and diarrhea, and dermatological side effects including hand-foot syndrome and skin pigmentation change. However, neurological side effects of capecitabine are very rare. We describe herein a patient who developed neurological side effects in the form of agraphia and dysarthria on the 7th day of capecitabine treatment. CASE REPORT: A 34-year-old male patient, who was being followed up with the diagnosis of colon cancer, presented with speech and writing disorder that developed while under capecitabine treatment. Dysarthria and agraphia were detected in his neurological examination. Diffusion-weighted magnetic resonance imaging (MRI) revealed acute diffusion restriction in the splenium of the corpus callosum and at the level of the bilateral centrum semiovale. Brain MRI revealed symmetrical T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) signal increases at the right temporoparietal medial, corpus callosum level, and bilateral white matter level. MANAGEMENT & OUTCOME: The capecitabine treatment was terminated, and methylprednisolone treatment was administered and plasmapheresis procedure was carried out. Subsequently, significant improvement was observed in the clinical findings and neuroimaging. DISCUSSION: Capecitabine is used as an oral agent; thus, it provides ease of use. Neurological side effects associated with the use of capecitabine reportedly occur very rarely. The findings of this case demonstrated that leukoencephalopathy can be seen during the use of capecitabine, imaging results are very important in the diagnosis of leukoencephalopathy, and improvement can be achieved with the termination of the capecitabine treatment.

Vestibular migraine, demographic and clinical features of 415 patients: A multicenter study.

OBJECTIVE: To evaluate demographic and clinical features of vestibular migraine (VM) patients METHODS: Four hundred fifteen patients with VM were evaluated by using a structured questionnaire in addition to clinical examination. RESULTS: The mean age of headache and vertigo onset was 25 years and 39 years, respectively. In 12.3%, benign paroxysmal positional vertigo (BPPV) was detected during the interictal period. Ten percent had hearing loss on audiometry, in 8.7% it was one-sided low-frequency sensory-neural hearing loss below 2000 Hz and the history was typical for Meniere's disease (MD) in addition to VM. Tinnitus was present in 94.4%, aural fullness in 83.4%, nausea in 72.2% and vomiting in 30.5% of patients with VM/MD. The prevalence of these symptoms was higher in patients with VM/MD than in pure VM. Median attack severity determined by visual analog scale measured in centimeters from 0 to 10 was 8 for headache and 7 for vertigo for the whole group. Severe headache was significantly correlated with age of ≤ 43 years (OR: 6.831, 95% CI: [4.10-11.63]; p < 0.001) and severe vertigo was significantly correlated with age ≥ 41 years (OR: 7.073, 95% CI: [4.55-10.98]; p < 0.001). Motion sickness was revealed from past medical history in 51.8%. Family history of migraine was present in 72.5% and the age of onset of both migraine headaches (p = 0.008) and vertigo attacks (p = 0.004) was lower in these patients. CONCLUSION: Younger patients suffered more severe headache attacks whereas vertigo attack severity was higher in the elderly. BPPV and MD were commonly associated with VM and VM/MD was accompanied by aural and autonomic features more frequently than pure VM. Previous history of motion sickness was detected in more than half of the whole group. Family history of migraine was associated with younger onset of migraine headaches and vertigo attacks.

Factors determining the response to treatment in patients with vestibular migraine.

PURPOSE: To find out clinical features associated with poor response to treatment in vestibular migraine (VM). METHODS: VM patients treated with drugs recommended in migraine prophylaxis were included in this multicenter study. Migraine features including type, age of onset of headache and vertigo attacks, attack frequency, intensity, associated symptoms, triggering factors, presence of interictal dizziness/imbalance, anxiety, depression, history of motion sickness, and family history of migraine were noted. Amitriptyline, flunarizine, propranolol, topiramate and venlafaxine were chosen depending on patients' individual requirements. Maximum dose of each drug was tried for 2 months to decide its efficacy. In the case of inefficacy, it was changed with another preventive drug of different class. If there was still no improvement, two drugs of different classes were combined. ≥ 50% reduction in attack frequency and severity in patients using one drug and a combination of two drugs was compared, with patients showing <50% reduction despite combination therapy, regarding their clinical features. RESULTS: The results of 430 VM patients, 65 men and 365 women with a mean age of 42.2 ± 12.2 years (range: 17-74 years), were analyzed. CONCLUSION: Cutaneous allodynia frequently associated with female sex, comorbid anxiety and depression and interictal dizziness/imbalance enhanced with comorbid anxiety were risk factors for reduced treatment response. Aural fullness might be the clue of impending concomitant Meniere's disease not responding to migraine preventives.

Clinical features and risk factors of angiography headache and evaluation of its relationship to primary headaches.

INTRODUCTION: Angiography headache is defined as a new headache caused directly by cerebral angiography. We aimed to investigate the prevalence and clinical characteristics of angiography headache, and its relationship with primary headaches. MATERIAL AND METHODS: This single-centre prospective cohort study was carried out in our tertiary healthcare centre. Patients who had undergone a diagnostic cerebral angiography procedure between March 2016 and June 2017 were included in the study. During and after the procedure, we evaluated the patients in terms of occurrence of headache, and, if present, details about time to onset of headache after cerebral angiography, duration of headache, accompanying symptoms (nausea, vomiting, photophobia and phonophobia), and degree and severity of pain. RESULTS: A total of 226 patients were included in the study. The prevalence of angiography headache was found to be 22.1% (n = 50). While angiography headache started in the first six hours in 92% (n = 46) of the patients, it started after 24 hours of the angiography procedure in only 4% (n = 2). Compressive headache was the most common type, described by 64% of the patients, whereas 4% of the patients described pricking or stabbing sensations. Angiography headache was associated with female gender, higher educational level, and a history of primary headache. CONCLUSION: Angiography headache is an important clinical entity that must be considered during and after angiography. Experiencing angiography headache is more common among patients with a history of primary headache.

The Incidence and the Risk Factors of Silent Embolic Cerebral Infarction After Coronary Angiography and Percutaneous Coronary Interventions.

Silent embolic cerebral infarction (SECI) is a major complication of coronary angiography (CAG) and percutaneous coronary intervention (PCI). Patients with stable coronary artery disease (CAD) who underwent CAG with or without PCI were recruited. Cerebral diffusion-weighted magnetic resonance imaging was performed for SECI within 24 hours. Clinical and angiographic characteristics were compared between patients with and without SECI. Silent embolic cerebral infarction occurred in 12 (12%) of the 101 patients. Age, total cholesterol, SYNTAX score (SS), and coronary artery bypass history were greater in the SECI(+) group (65 ± 10 vs 58 ± 11 years,P= .037; 223 ± 85 vs 173 ± 80 mg/dL,P= .048; 30.1 ± 2 vs 15 ± 3,P< .001; 4 [33.3%] vs 3 [3.3%],P= .005). The SECI was more common in the PCI group (8/24 vs 4/77,P= .01). On subanalysis, the SS was significantly higher in the SECI(+) patients in both the CAG and the PCI groups (29.3 ± 1.9 vs 15 ± 3,P< .01; 30.5 ± 1.9 vs 15.1 ± 3.2,P< .001, respectively). The risk of SECI after CAG and PCI increases with the complexity of CAD (represented by the SS). The SS is a predictor of the risk of SECI, a complication that should be considered more often after CAG.

Gender influences headache characteristics with increasing age in migraine patients.

BACKGROUND AND AIMS: Migraine headache is one of the most common primary headache disorders and is three times more prevalent in women than in men, especially during the reproductive ages. The neurobiological basis of the female dominance has been partly established. The present study aimed to investigate the effect of gender on the headache manifestations in migraine patients. METHODS: The study group consisted of 2082 adult patients from five different hospitals' tertiary care-based headache clinics. The relationship between headache characteristics and gender was evaluated in migraine with aura (MwA) and migraine without aura (MwoA). The duration, severity, frequency of headache and associated symptoms were evaluated in both genders and age-dependent variations and analyzed in two subgroups. RESULTS: Women with migraine were prone to significantly longer duration and intensity of headache attacks. Nausea, phonophobia and photophobia were more prevalent in women. Median headache duration was also longer in women than in men in MwA (p = 0.013) and MwoA (p < 0.001). Median headache intensity was higher in women than in men in MwA (p = 0.010) and MwoA (p = 0.009). The frequency of nausea was significantly higher in women than in men in MwA (p = 0.049). Throbbing headache quality and associated features (nausea, photophobia, and phonophobia) were significantly more frequent in women than in men in MwoA. The gender impact varied across age groups and significant changes were seen in female migraineurs after age 30. No age-dependent variation was observed in male migraineurs. CONCLUSION: Gender has an influence on the characteristics of the headache as well as on the associated symptoms in migraine patients, and this impact varies across the age groups, particularly in women.

Fibromuscular Dysplasia and Intravenous Thrombolytic Treatment.

Fibromuscular dysplasia (FMD), which usually affects middle-aged and older women, is a non-atheromatous and non-inflammatory angiopathy. Definitive diagnosis is made only by angiography showing classic string-of-beads appearance. In this article, we present a patient with acute ischemic stroke due to FMD who was successfully treated with thrombolytic therapy as well as to revise the approach to FMD in the light of the literature.

Are the Comments on HaNDL Syndrome in the ICHD-II Sufficient?

A 33-year-old man was admitted to our emergency department for severe frontal headache followed by a state of consciousness disturbance and right-sided hemiparesis. No previous febrile disease, head trauma, vascular risk factor, and medication for any systemic disease were defined in his history. He had experienced a similar disorder three years ago and had recovered completely. Cerebrospinal fluid (CSF) analysis revealed pleocytosis and electroencephalography (EEG) showed diffuse slow wave activity. Hyperintense foci on T2 and FLAIR sequences representing bilateral cortical ischemia, prominent on the right hemisphere, were seen on MRI. Contrast-enhanced T1 images showed marked leptomeningeal thickening with enhancement. The patient was considered as having CSF lymphocytosis (HaNDL syndrome) due to temporary headache with neurologic deficit and CSF pleocytosis. Diagnostic criteria have been identified for this syndrome according to the International Classification of Headache Disorders, 2nd edition (ICHD-II). According to these criteria, neuroimaging should be normal. Positive neuroimaging findings and impairment of consciousness have been reported in a limited number of HaNDL cases so far. Diversity of neurological signs, duration and distinctness from migraine headache have been described in comment section under the diagnostic criteria. Comments are inadequate in this regard.

Comorbidity of Migraine.

Migraine is a common neurological disorder and can be severely disabling during attacks. The highest prevalence occurs between the ages of 25 and 55 years. Prior studies have found that migraine occurs together with other illnesses at a greater coincidental rate than is seen in the general population. These occurrences are called "comorbidities". To delineate the comorbidities of migraine is important, because it can help improve treatment strategies and the understanding of the possible pathophysiology of migraine.

Recurrent headache and MRI findings in systemic lupus erythematosus.

BACKGROUND: Headache in patients with systemic lupus eryhtematosus (SLE) is considered a common neurological finding, although the relationship is unclear. Another obscure point is the relationship between headache and neuroradiologic findings in these patients. AIM: In this study, we aimed to evaluate the correlation between headache characteristics and intracranial lesions in SLE patients. METHODS AND RESULTS: Forty-eight SLE patients were chosen from those referred to our clinic depending on the American Collage of Rheumatology (ACR) criteria at the same time or after the diagnosis of SLE. Headache classification was done regarding the ICD-II criteria in the patients. Headache severity was assessed by visual analog scale (VAS), and subjects with VAS > or = 4 were included in the study. Patients were divided into two groups according to magnetic resonance imaging (MRI) findings: abnormal MRI (lesion positive) and normal MRI (lesion negative). On MRI, intracranial lesions were detected in 37.5% (n = 18) of the patients, and no lesion was found in 62.5% (n = 30). Headache characteristics were as tension type in 54.1% (n = 26) and migraine like in 39.6% (n = 19) of all patients. Imaging findings were mostly as periventricular and subcortical focal lesions, ranging from 3-22 mm in diameter. A significant correlation was found between abnormal MRI findings with advanced age and prolonged disease duration (p = 0.018, p = 0.016). CONCLUSIONS: As a conclusion, a detailed neurologic evaluation and radiologic investigation, if necessary, should be performed in SLE patients with prolonged disease and advanced age, regardless of headache characteristics.

Prevalence of migraine diagnosis using ID Migraine among university students in southern Turkey.

In this prospective study, we aimed to determine the prevalence of migraine and non-migraine headaches using a questionnaire, including ID Migraine, for university students. The study was designed cross-sectionally and a questionnaire consisting of 43 questions was applied to 1,256 students. The questionnaire consisted of questions related to demographic, social, curriculum, housing and headache characteristics of the subjects. Three-item screening questions of the ID Migraine test were included at the end of the questionnaire aimed at migraine diagnosis. The mean age of 1,256 students (529 females and 727 males) enrolled in this study was 21.9 +/- 2.1 years (17-31 years). Migraine-type headache was detected in 265 subjects (21.9%) based on the ID Migraine evaluation. Of these, 145 (54.7%) were female and 120 (45.3%) were male (female/male ratio: 1.2/1). Non-migraine-type headache was identified in 864 subjects, with 357 females and 507 males. As a conclusion, ID Migraine screening test might be practical and beneficial when a face-to-face interview is not possible or to pre-determine the subjects for a face-to-face interview for migraine diagnosis in larger populations.

QT dispersion on ECG in acute ischemic stroke and its impact on early prognosis.

OBJECTIVE: To evaluate the effects of corrected QT dispersion (QTcd) on patients` prognosis with early stage non-lacunar ischemic stroke, regardless of location of the lesion. METHODS: In this non-randomized prospective study, stroke patients were evaluated in the intensive care unit of Cukurova University Hospital, School of Medicine, Adana, Turkey, from 2002-2003. Neurologic symptoms of all subjects were recorded according to Glasgow Coma Scale (GCS) and Canadian Neurological Scale. Subtypes of stroke were defined according to the Oxfordshire Community Stroke Project classification. Patients with GCS between 7 and 11 were included in the study. Electrocardiograms of the patients were collected in the first 6 hours. Corrected QT (QTc) were calculated by the Bazzett formula. Corrected QT dispersion was defined as maximum minus minimum QT interval. RESULTS: A total of 148 (74 male) consecutive acute stroke patients, aged between 36-90 years (mean 63.07 +/- 12.55), were divided into 2 groups. Group I consisted of surviving patients (n=109) and Group II consisted of expired patients (n=39). There were no statistically significant differences in the mean age, gender distribution, frequency of hypertension, diabetes mellitus, and coronary artery disease between the groups. Group II (7.4 +/- 3.7) had significantly higher QTcd (7.4 +/- 3.7) compared to Group I (p=0.002). CONCLUSION: This study shows the value of QTcd in predicting patients` prognoses with early stage non-lacunar ischemic stroke, regardless of location of the lesion.

Headache characteristics in senior medical students in Turkey.

Headache is one of the most common neurological complaints of the young population and it affects the quality of life due to limitation of daily activities. In this study, our main goal was to appraise the general headache characteristics in senior medical students just before graduation and to determine the impact of headache on the quality of life, as well as the general attitude of students about their headaches. The study group consisted of 141 senior students. As the first step, the question about "having headache within the past one year period" was asked. Of the 141 students, 127 students answering "yes" were invited to a face-to-face interview. Of these, 67 students (52.8%) participated in the second evaluation. The second evaluation consisted of history taking and neurological and physical examination. All subjects were classified according to the International Classification of Headache Disorders (2nd edition) criteria. Validated Turkish version of Migraine Disability Assessment questionnaire was given to the subjects to evaluate the socio-economical impact of headache. Tension-type headache, which is the most common form of primary headaches, was identified in 34 students (50.7%) out of 67 students. Migraine was detected in 31 students (46.3%). This is the first study performed on a face-to-face interview basis with medical students using the new classification criteria in Turkey. Astonishingly, most of the students (n:65) ignored their headaches and did not seek medication, despite the negative impact of headache on daily functioning and overall quality of life.