The Prevalence of Osmophobia in Migranous and Episodic Tension Type Headaches.

BACKGROUND: Migraines are a neurological disease, of which the most common symptom is an intense and disabling episodic headache. Many persons experience sensory hyper excitability manifested by photophobia, phonophobia and osmophobia. This study was planned to investigate the prevalence of osmophobia in migranous and episodic tension type headache (ETTH). MATERIALS AND METHODS: A semi-structured questionnaire was administered to all patients to evaluate the eventual presence of osmophobia during a headache attack and different characteristics of osmophobia were determined. RESULTS: Osmophobia reported in 84% with migranous headache with aura, 74% of migranous patients without aura and in 43.3% of those with ETTH. In 50% of patients, osmophobia was present in all of their headache attacks, 11.7% had osmophobia in more than half of their attacks (from 10 attacks they reported osmophobia in 5-9 ones) and others had this sign in less than half of their attacks (from 10 attacks they reported osmophobia in less than 5 ones). Most frequently the offending odors were scents (88%), foods (54.2%) and cigarette smoke (62.5%). Osmophobia starts 30 min before the headache starts in 22.7% of patients. CONCLUSION: Osmophobia appears structurally integrated into the migraine history of the patient; however, for differential diagnosis with ETTH, other criteria are necessary.

The value of transcranial Doppler derived pulsatility index for diagnosing cerebral small-vessel disease.

BACKGROUND: The pulsatility index (PI), measured by transcranial Doppler (TCD) ultrasonography, can reflect vascular resistance induced by cerebral small-vessel disease (SVD). We evaluated the value of TCD-derived PI for diagnosing SVD as compared with magnetic resonance imaging (MRI). MATERIALS AND METHODS: Fifty-six consecutive cases with SVD (based on MRI) and 48 controls with normal MRI underwent TCD. Based on MRI findings, patients were categorized into five subgroups of preventricular hyperintensity (PVH), deep white matter hyperintensity (DWMH), lacunar, pontin hyperintensity (PH), and PVH+DWMH+lacunar. The sensitivity and specificity of TCD in best PI cut-off points were calculated in each group. RESULTS: The sensitivity and specificity of TCD in comparison with MRI with best PI cut-off points were as follows: In PVH with PI = 0.83, the sensitivity and specificity was 90% and 98%, respectively. In DWMH with PI = 0.79, the sensitivity and specificity was 75% and 87.5%, respectively. In lacunar with PI = 0.80, the sensitivity and specificity was 73% and 90%, respectively. In PH with PI = 0.69, the sensitivity and specificity was 92% and 87.5%, respectively. And, in PVH+DWMH+lacunar subgroup with PI = 0.83, the sensitivity and specificity was 90% and 96%, respectively. CONCLUSIONS: Increased TCD derived PI can accurately indicate the SVD. Hence, TCD can be used as a non-invasive and inexpensive method for diagnosing SVD, and TCD-derived PI can be considered as a physiologic index of the disease as well.

Evaluation of relationship between breast cancer and migraine.

BACKGROUND: Frequency of migraine changes at different times of a woman's reproductive cycle because of fluctuation of estrogen levels. Breast cancer has also a link with hormonal changes. Given this fact that both migraine and breast cancer are affected by estrogen, the prevalence of migraine may be different in breast cancer patients compared to the normal population. MATERIALS AND METHODS: In this case-control study, two groups of women with and without breast cancer were compared regarding the prevalence of migraine. Each group consisted of 400 women. The diagnosis of different types of headache was made based on The International Headache Society (IHS) guidelines. Type of headache, type and receptor status of breast cancer, as well as history of taking hormonal medications was recorded. Independent t-test and Chi-square tests were used for data analysis. RESULTS: Relative frequency of migraine headache in the normal woman was 38% compared to 19% in the breast cancer group (P < 0.0001). Tension headache was also significantly more prevalent in the normal group (P < 0.001). The frequency of migraine was significantly lower in estrogen receptor (ER)+/progesterone receptor (PR)- women compared to ER-/PR+ (26 and 43 women, respectively; P = 0.04); however, this difference was not significant for tension headache (P = 0.68). CONCLUSION: This study confirmed the lower frequency of migraine, as well as tension headache, in breast cancer sufferers. This could be contributed to several non-hormonal factors, such as a history of long term use of nonsteroidal anti-inflammatory drugs (NSAIDs), and hormonal factors, although only migraine showed a strong link with hormone status.

Reliability and validity of the migraine disability assessment scale among migraine and tension type headache in Iranian patients.

INTRODUCTION: MIDAS is a valid and reliable short questionnaire for assessment of headache related disability. Linguistic validation of Persian MIDAS and assessment of psychometric properties between tension type headache (TTH) and migraine were the aims of this study. METHODS: Patients with migraine or TTH were included. At the first visit, we administered a headache symptom questionnaire, MIDAS, and SF-36. Patients filled out MIDAS in second and third visit within three and eight weeks after base line visit. Internal consistency (Cronbach α ) and test-retest reproducibility (Spearman correlation coefficient) were used to assess reliability. Convergent validity and MIDAS capability to differentiate between chronic and episodic headaches (migraine and TTH) were also assessed. RESULTS: The 267 participants had episodic migraine (EM-64%), chronic migraine (CM-13.5%), episodic TTH (ETTH-13.5%), and chronic TTH (CTTH-9). Internal consistency reliability was 0.8 for the entire sample, 0.72 for TTH, and 0.82 for migraine. Test-retest reliability for all questions between visit 1 and visit 2 varied from 0.54 to 0.71. Convergent validity was assessed using SF-36 as an external referent. Patients with episodic headaches (EM and ETTH) had significantly lower MIDAS scores than chronic headaches (CM and CTTH). CONCLUSION: Persian MIDAS is a valid and reliable questionnaire for migraine and TTH that can differentiate between episodic headache and chronic headache.

Reliability and Validity of the Persian HIT-6 Questionnaire in Migraine and Tension-type Headache.

OBJECTIVE: Headache Impact Test (HIT-6) measures the impact headaches in a 1-month period. We validated the Persian translation of HIT-6, compared the HIT-6 psychometric analysis between migraine and tension-type headache (TTH) patients, and evaluated the capability of HIT-6 to differentiate between TTH, chronic migraine, and episodic migraine. METHODS: Qualified participants, including 274 patients diagnosed with migraine or TTH, were required to complete HIT-6, SF-36v2, and a symptoms questionnaire on their first visit. At 3 and 8 weeks from first visit, participants completed HIT-6. Internal consistency (Cronbach's α) and test-retest reproducibility (Pearson's correlation coefficient) were used to assess reliability. Convergent validity was also assessed. RESULTS: Tension-type headache, episodic, and chronic migraines included 24.5%, 61.9%, and 13.6% of the participants, respectively. Internal consistency among all patients, TTH, and migraine in the first visit were 0.74, 0.77, and 0.73, respectively. Test-retest reliability for HIT-6 between visit 1 and 2 showed a moderate level of correlation (r = 0.50). Convergent validity and also item total correlation were acceptable. There was no significant difference in HIT-6 total score between TTH and migraine. CONCLUSION: Persian HIT-6 is a valid and reliable questionnaire for the evaluation of headache. However, it cannot differentiate between chronic migraine, episodic migraine, and TTH in Iranian population.

The psychometric properties of the persian migraine-specific quality of life questionnaire version 2.1 in episodic and chronic migraines.

BACKGROUND: Migraine-specific quality of life (MSQ) is a valid and reliable questionnaire. Linguistic validation of Persian MSQ questionnaire, analysis of psychometric properties between chronic and episodic migraine patients, and capability of MSQ to differentiate between chronic and episodic migraines were the aims of this study. METHOD: Participants were selected from four different neurology clinics that were diagnosed as chronic or episodic migraine patients. Baseline data included information from MSQ v. 2.1, MIGSEV, SF-36, and symptoms questionnaire. At the third week from the baseline, participants filled out MSQ and MIGSEV. Internal consistency (Cronbach alpha) and test-retest reproducibility (intraclass correlation coefficients) were used to assess reliability. Convergent and discriminant validities were also assessed. RESULTS: A total of 106 participants were enrolled. Internal consistencies of MSQ among all patients, chronic and episodic migraines, were 0.92, 0.91, and 0.92, respectively. Test-retest correlation of MSQ dimensions between visits 1 and 2 varied from 0.41 to 0.50. Convergent, item discriminant, and discriminant validities were approved. In all visits MSQ scores were lower in chronic migraine than episodic migraine; however, the difference was not statistically significant. CONCLUSION: Persian translation of MSQ is consistent with original version of MSQ in terms of psychometric properties in both chronic and episodic migraine patients.

Prevalence and clinical characteristics of headache among medical students, Isfahan, Iran.

BACKGROUND: Headache is one of the most common complaints during medical curriculum and it occurs due to numerous psychological and physical stressors, which are more common in medical students than general population. The purpose of this study was to evaluate the frequency of different types of headache and associated factors. MATERIALS AND METHODS: This cross-sectional study was conducted in Isfahan University of Medical Sciences, from September 2011 to January 2012. First- to seven-year medical students who have experienced some forms of headache in their life and had headache attacks during the past 6 months were included in this study. All medical students completed a structured check list, which consisted of demographics data, associated factors, and headache characteristics. RESULTS: A total of 480 (258 [53.8%] males and 222 [46.2%] females) students (93.7%) were evaluated. The prevalence of headache was 58.7%, the prevalence of migraine, and tension-type headache was 14.2% (10.5% in male vs. 18.5% in female, P = 0.08) and 44.2% (49.2% in male vs. 39.2% in female, P = 0.006), respectively. A family positive history was found in 9.5% of students with headache. The lower socio-economic status, year of study (3(rd) and 5(th) year students), was seemed to had higher prevalence in students with headache. There was no significant difference between headache and concomitant disease. CONCLUSION: The results demonstrate that prevalence of headache is high among medical student. Socio-economic and the year of study might be significant factors in the prevalence of headache. Further multicenter studies would be necessary to evaluate headache epidemiology among medical students in the whole country.

Mutation analysis of CACNA1A gene in Iranian migrainous and review literatures.

BACKGROUND: There are contrary results about the role of CACNA1A gene in the causation of common migraine in different populations. However, migraine may be genetically heterogeneous and more studies in different families and populations are required for a definite conclusion. The aim of this study was to surveyed leukocyte genomic DNA mutation of CACNA1A in Iranian migraine patients with [MA] and without aura [MO] who has family history of migraine and we performed a narrative review of all studies that evaluated CACNA1A gene, non-hemiplegic migraine [MA and MO] and FHM [familial hemiplegic migraine]. MATERIALS AND METHODS: The 30 patients with family history of migraine were selected for mutations analysis for CACNA1A gene by PCR method. For review, we searched MEDLINE-PUBMED, ISI, Scopus and Cochrane databases up to December 2012. RESULTS: Mutation analysis of the 4 exons of the CACNA1A gene in these patients revealed no mutations in this gene. Direct sequencing revealed a polymorphism previously reported G to A transition in the exon 16 [nt2369, G→A] in 9 patients. In review, the correlation of FHM loci [CACNA1A gene] with MA and MO has been showed in different population and only small population from Caucasians presented this correlation. CONCLUSION: CACNA1A is most likely not a major susceptibility gene for common migraine in Iranian maigrainous. It's essential to study more on larger series and covering all 47 exons of the CACNA1A gene to confirm this hypothesis.

The role of melatonin in the pathogenesis of multiple sclerosis: a case-control study.

BACKGROUND: The association between the prevalence of multiple sclerosis (MS) and latitude gradient indicates the importance of environmental factors in MS susceptibility. Sunlight's ultraviolet radiation, its ability to influence melatonin, and an imbalance of melatonin in the central nervous system (CNS) may be involved in this process. METHODS: This case-control study was conducted in Isfahan MS Society (IMSS), Isfahan, Iran. Enrollment was limited to patients with MS referring to the MS clinic of Alzahra and Kashani hospital during January and February 2012. RESULTS: Thirty-five patients with MS and 35 healthy individuals were included in our study. The melatonin levels were analyzed using enzyme-linked immunosorbent assay (ELISA) kits. There was no significant difference between saliva melatonin level of two groups (patients and healthy individuals) (P = 0.417); however, after controlling the effect of age, a significant difference (P = 0.022) was found. CONCLUSIONS: In the present study, it is proposed that environmental conditions in Isfahan city might have increased the susceptibility to MS, but more studies in different parts of the world are needed to evaluate this claim.

Comparison of the administration of progesterone versus progesterone and vitamin D in improvement of outcomes in patients with traumatic brain injury: A randomized clinical trial with placebo group.

BACKGROUND: Due to the heterogeneity of traumatic brain injury (TBI), many of single treatments have not been successful in prevention and cure of these kinds of injuries. The neuroprotective effect of progesterone drug on severe brain injuries has been identified, and recently, the neuroprotective effect of vitamin D has also been studied as the combination of these two drugs has shown better effects on animal samples in some studies. This study was conducted to examine the effect of vitamin D and progesterone on brain injury treatment after brain trauma. MATERIALS AND METHODS: This study was performed on patients with severe brain trauma (Glasgow Coma Scale (GCS) ≤ 8) from April to September, 2011. The patients were divided to 3 groups (placebo, progesterone, progesterone-vitamin D), each with 20 people. Upon the patients' admission, their GCS and demographic information were recorded. After 3 months, they were reassessed, and their GCS and GOS (Glasgow outcome scale) were recorded. The collected data were analyzed using SPSS 18 software (SPSS Inc., Chicago IL, USA). RESULTS: Before intervention, GCS mean of the placebo, progesterone, and progesterone-vitamin D groups were 6.3 ± 0.88, 6.31 ± 0.87, and 6 ± 0.88, respectively. They increased to 9.16 ± 1.11, 10.25 ± 1.34, and 11.27 ± 2.27, respectively 3 months after intervention. There was a significant difference among GCS means of the 3 groups (P-value = 0.001). GOS was classified to 2 main categories of favorable and unfavorable recovery, of which, favorable recovery in placebo, progesterone, and progesterone-vitamin D was 25%, 45%, and 60%, respectively which showed a statistical significant difference among the groups (P-value = 0.03). CONCLUSION: The results showed that recovery rate in patients with severe brain trauma in the group receiving progesterone and vitamin D together was significantly higher than that of progesterone group, which was in turn higher than that of placebo group.

Cigarette smoking and the risk of multiple sclerosis: a sibling case-control study in Isfahan, Iran.

AIMS: We aimed to study the smoking habits of multiple sclerosis (MS) patients and their healthy siblings in Isfahan province in Iran. METHODS: MS patients registered with the Isfahan MS society database were compared to their healthy siblings who served as controls. Data regarding the smoking habits of patients and their siblings were collected using a specially designed questionnaire. Conditional logistic regression was adopted to analyze the association of smoking with the risk of MS, adjusting for age and sex. RESULTS: There were 1,606 participants with 516 cases and 1,090 controls. After adjustments for age and sex, subjects who were ever-smokers had a significant risk of developing MS [odds ratio (OR) 2.67; 95% confidence interval (CI) 1.70-4.21; p <0.001]. Past smokers (OR 8.83; 95% CI 3.98-19.60; p < 0.001) and current smokers (OR 1.84; 95% CI 1.10-3.10; p = 0.021) had a significant risk for developing MS. Disease progression (current expanded disability status scale/disease duration) was not different between smokers and nonsmokers (0.54 ± 0.42 vs. 0.49 ± 0.48; p = 0.61). CONCLUSION: Using a sibling pair method our data confirm the association between smoking and MS. A degree of confounding due to overmatching between siblings was unavoidable, but any bias would be conservative and should have lessened the effect of smoking.

Comparison of validity and reliability of the Migraine disability assessment (MIDAS) versus headache impact test (HIT) in an Iranian population.

BACKGROUND: Migraine is one of the most common headaches that affect 11% or more adult population. Recently, researchers have designed two questionnaires, namely Headache Impact Test (HIT) and Migraine Disability Assessment (MIDAS), with the aim of improving migraine care. These two tests provide a standard measurement about migraine's effects on people's life style that divide patients into 4 groups (grades) based on headaches intensity. The aim of this study was to compare the validity and reliability of these two tests. METHODS: This study was designed as a multicenter, descriptive study to compare validity and reliability of Persian version of MIDAS and HIT questionnaires in 240 males and females with a migraine diagnosis according to criteria for headache and facial pain of the International Headache Society (IHS). The patients were enrolled in the study from 3 neurology clinics in Isfahan, Iran, between July 2004 and January 2005 and were evaluated at baseline (visit 1) and 4 weeks later (visit 2). RESULTS: According to our study, there was a high correlation between two tests (r = 0.94). This decreased their MIDAS grade in comparison to their grade HIT questionnaire. CONCLUSION: These findings demonstrated that Persian version of HIT have the same validity and reliability as MIDAS. Replying to HIT questionnaire was easier than MIDAS for Iranian patients. Physicians can reliably use the Persian translation of both MIDAS and HIT questionnaires to define the severity of illness and its treatment strategy as a self-administered report by migraine patients. However, we recommend HIT for its simplicity in headache clinics.

Evaluation of the effect of donepezil on cerebral blood flow velocity in Alzheimer's disease.

OBJECTIVES: To evaluate the effect of Donepezil on cerebral blood flow velocity using non-invasive transcranial Doppler (TCD) sonography. METHODS: This clinical trial was carried out in the Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran from March 2008 to July 2009, on Alzheimer's disease (AD) patients in 2 groups of case and control, each consisting of 11 patients. The case group who received Donepezil medication was examined by TCD before (baseline), after 4 weeks of oral treatment with 5 mg per day Donepezil, and a further 4 weeks of 10mg per day Donepezil, orally. The control group comprised AD patients who did not receive any medications, and were examined by TCD only once. Peak systolic (PSV), end-diastolic (EDV), and mean flow (MFV) velocities of the posterior cerebral artery (PCA) and the middle cerebral artery (MCA) was assessed by TCD. Also, mini-mental state examination (MMSE) was carried out. RESULTS: There were no significant differences between the case and control groups, in terms of age and gender. In the case group, the mean MMSE score reached 20.2 +/- 2.8 from a baseline value of 15.8 +/- 3.3 after 4 weeks of oral treatment with 5 mg/d Donepezil, and reached 20.6 +/- 3.9 after 4 more weeks at 10 mg/d Donepezil. In the MCA, the difference in PSV and MFV values after 4 weeks of treatment with 10 mg/d Donepezil was statistically significant compared with the baseline values. In PCA, the values of MFV and EDV after 4 weeks of treatment with 10 mg/d Donepezil were statistically significant in comparison with the baseline value. CONCLUSION: Donepezil (10 mg/d) increased cerebral blood flow velocity and MMSE score in our AD patients, but more extensive trials are recommended.

The assessment value of transcranial Doppler sonography versus magnetic resonance angiography in vertebrobasilar stroke.

BACKGROUND: The goal of this study was to determine the reliability of TCD in evaluation of vertebrobasilar arteries in comparison with brain MRA in patients suffering from acute vertebrobasilar stroke. METHODS: Samples were patients with definite clinical diagnosis of vertebrobasilar stroke. For all patients brain MRI, MRA and TCD were performed during the first 48 hours of admission. Basilar artery was insonated at the depth of 75 to 85 mm and vertebral arteries were insonated at the depth of 45 to 55 mm. On brain MRA, the degree of stenosis in vertebrobasilar arteries was graded from I (normal) to IV (total stenosis) and the correlation between the grade of stenosis and TCD indices were studied. RESULTS: Spearman correlation test revealed a significant correlation between mean flow velocity (MFV) and MRA grading (correlation coefficient = -0.486) as well as end diastolic velocity (EDV) and MRA grading (correlation coefficient = -0.323) with no significant correlation between pulsatility index, peak systolic velocity and MRA grading (p > 0.05). One way ANOVA analysis showed that there was only significant mean MFV and mean EDV difference between grade 1 and other grades. CONCLUSIONS: TCD was only able to differentiate between stenotic and normal pattern and could not assist in the grading of stenosis. On the other hand, in acute vertebrobasilar stroke that TCD performed blindly without visualization of arteries and in a fixed depth it might have limited value in the grading of vertebrobasilar system stenosis.

Cerebral vasospasm following traumatic subarachnoid hemorrhage.

BACKGROUND: Cerebral vasospasm is a preventable cause of death and disability in patients who experience aneurysmal subarachnoid hemorrhage (SAH). The aim of this study is to investigate the incidence of cerebral vasospasm following traumatic SAH and its relationship with different brain injuries and severity of trauma. METHODS: This cross-sectional study was conducted from October 2006 to March 2007 in department of Neurosurgery in Al-Zahra Hospital. Consecutive head-injured patients who had SAH on the basis of an admission CT scan were prospectively evaluated. The severity of the trauma was evaluated by determining Glasgow Coma Scale (GCS) score on admission. Transcranial Doppler ultrasonography evaluations were performed at least 48 hours after admission and one week thereafter. Vasospasm in the MCA and ACA was defined by mean flow velocity (FV) of more than 120 cm/sec with a Lindegaard index (MVA/ICA FV ratio) higher than 3. Basilar artery vasospasm was defined by FV higher than 85 cm/sec. RESULTS: Seventy seven patients with tSAH were enrolled from whom 13 were excluded. The remaining were 52 (81.2%) men and 12 (18.7%) women, with a mean age of 37.89 years. Trauma was severe in 11 (17.2%), moderate in 13 (20.3%), and mild in 40 (62.5%) patients. From all, 27 patients (42.1%) experienced at least one vasospasm during the study period and MCA vasospasm was the most common in the first and second weeks (55.5%). CONCLUSIONS: Traumatic SAH is associated with a high incidence of cerebral vasospasm with a higher probability in patients with severe TBI.

Comparison of the effect of topiramate and sodium valporate in migraine prevention: a randomized blinded crossover study.

BACKGROUND: Topiramate and sodium valporate are anticonvulsants, demonstrated to be effective as monotherapy for migraine prevention in placebo-controlled trials. OBJECTIVES: To compare the relative efficacy of topiramate and sodium valporate in the prevention of migraine. PATIENTS AND METHODS: A 24-week, randomized, double-blind, crossover, clinical trial was conducted from October 2003 to September 2004. A total of 64 patients with migraine headache, aged 14 to 57 years, were randomly allocated to the 2 treatment groups. The first group received topiramate (25 mg daily increment over 1 week to 50 mg) for a total of 2 months. The second group received sodium valporate (200 mg daily increment over 1 week to 400 mg) for 2 months. Response to treatment was assessed at 0, 1, 8, 16, and 24 weeks after start of therapy. RESULTS: Topiramate appeared to be equivalent in efficacy and safety to sodium valporate. A significant decrease in duration, monthly frequency, and intensity of headache occurred in both groups. Of the 32 patients treated with sodium valporate, the mean standard deviation (SD) of monthly migraine frequency decreased from 5.4 (2.5) to 4.0 (2.8) episode per month, headache intensity from 7.7 (1.2) to 5.8 (1.7) by visual analog scale (VAS), and headache duration from 21.3 (14.6) to 12.3 (10.7) hours (P < .001). Correspondingly, in the 32 patients treated with topiramate, the mean SD of monthly headache frequency decreased from 5.4 (2.0) to 3.2 (1.9) per month, headache intensity from 6.9 (1.2) to 3.7 (1.3), and headache duration from 17.3 (8.4) to 3.9 (2.7) hours (P < .001). CONCLUSION: This study demonstrates that treatment with topiramate and sodium valporate both significantly reduce migraine headache. This effect of topiramate and sodium valporate has previously been shown to reduce migraine headache, and we postulate that treatment with topiramate and sodium valporate may have a similar benefit.