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.

The effects of greater occipital nerve blockage with lidocaine on sleep characteristics in chronic migraine patients.

PURPOSE: The aim of our study was to determine the effects of greater occipital nerve block (GONB) with lidocaine on sleep characteristics in patients with chronic migraine. MATERIALS AND METHODS: Twenty female patients who underwent GONB with lidocaine were included in the study. The Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Pre-Sleep Arousal Scale (PSAS), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Restless Legs Syndrome Severity Scale (RLSSS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and headache diary results before and after the treatment of the patients were compared. RESULTS: We included 20 patients (all females) in our study. The mean age was 35.80 ± 8.82 years (range 24-50). After GON blockade, the number of days with pain (p < 0.001), duration of pain (p < 0.001), and Visual Analog Scale (VAS) score (p < 0.001) were significantly lower than before. After GONB, BDI (p = 0.007), BAI (p = 0.022), ISI (p = 0.009), and PSQI (p = 0.026) scores were significantly lower than before. After GONB, sleep quality was better than before (p = 0.035). CONCLUSION: This study showed that GONB with lidocaine can improve sleep quality, insomnia, and symptoms of depression and anxiety while reducing migraine headache.

Headache caused by the use of personal protective equipment in healthcare workers during the COVID-19 pandemic period.

Objective: Coronavirus 2019 disease (COVID-19), the cause of the ongoing pandemic, is an acute respiratory tract infection, which has made it necessary for healthcare personnel to use protective equipment such as N95 masks, protective goggles and visors. External compression headaches caused by the compression of the pericranial soft tissues by wearing hats, helmets, or goggles (worn during swimming or diving) have been previously described. In our study, we aimed to evaluate the presence and characteristics of personal protective equipment-associated headaches in healthcare workers during the COVID-19 pandemic period and to determine the effects of such headaches. Materials and methods: A face-to-face questionnaire was delivered to 300 male and female healthcare personnel between the ages of 18-56 working in healthcare units where COVID-19 patients were evaluated and treated. The data from 296 completed questionnaires was evaluated. Results: We included 296 participants (166 females and 130 males) in our study; the mean age was 33.98 ± 8.52 years (range 18-56). One hundred ninety-six (66.22%) participants indicated that they had new onset personal protective equipment-associated headaches. Percentages of those with newly emergent headaches because of protective equipment were higher in the following participant groups: females (p = 0.045), those with COVID-19 disease history (p < 0.001), and those diagnosed with headaches before the pandemic (p = 0.001). Conclusion: Our study showed the presence of new-onset headaches associated with personal protective equipment in healthcare workers during the COVID-19 pandemic. Personal protective equipment-related headaches were associated with the following factors: female sex, a history of COVID-19 disease, and the presence of primary headaches diagnosed before the pandemic.

Evaluation of the subfoveal choroidal and outer retinal layer thickness in obese women.

CLINICAL RELEVANCE: Obesity has become one of the most important health problems of today with its increasing prevalence. With the development of retinal imaging systems, obesity has been observed to be associated with changes in outer retinal layers and choroid in women. BACKGROUND: The aim of this study was to examine retinal layer parameters and their relationship with body mass index in obese women. METHODS: The study included 197 eyes of 197 women, of whom 44 were normal-weight, 40 were overweight, 40 were class 1 obese, 38 were class 2 obese, and 35 were morbidly obese. The thickness of the choroid was measured manually using an enhanced-depth imaging optical coherence tomography scanning program. RESULTS: The mean choroidal thickness values in five locations were lower than those of normal-weight, overweight, class 1, and class 2 obese women, in morbidly obese women (p < 0.05 for all). Subfoveal outer retinal layer thickness and specific sublayer thickness of the photoreceptor layer values were significantly lower in morbidly obese women than in normal-weight women, but there were no statistically significant differences between the groups in retinal pigment epithelium thickness and Bruch's membrane thickness (p = 0.001, p < 0.001, p = 1.00, and p = 0.101, respectively). Furthermore, there were significant negative relationships between body mass index and subfoveal choroidal thickness, subfoveal outer retinal layer thickness, and specific sublayer thickness of the photoreceptor layer values (r = -0.327, p < 0.001; r = -0.259, p < 0.001; and r = -0.281, p < 0.001, respectively). CONCLUSIONS: Morbid obesity was associated with a thinner choroid, subfoveal outer retinal layer, and specific sublayer thickness of the photoreceptor layer in women. Furthermore, retinal hypoxia associated with morbid obesity may be related to a decrease in photoreceptor layer thickness. Thinning of the outer retinal layer may also lead to atrophy of the cone sheath.

Relationship between Apnea-Hypopnea Index and Oxygen Desaturation in REM-Sleep Period and Morning Headache in Patients with Obstructive Sleep Apnea Syndrome.

INTRODUCTION: In patients with morning headache, REM sleep period decreases though little is known about its physiopathology. We evaluate the polysomnographic records of obstructive sleep apnea syndrome (OSAS) patients with the hypothesis that oxygen desaturations may be a better determinant in patients with morning headache, especially those in REM sleep periods. METHODS: Patient group (group 1) with a total of 361 patients with OSAS and the controls (group 2) with 107 healthy individuals were evaluated. The presence of morning headache was compared between the groups, and sleep parameters were correlated with morning headache. RESULTS: In group 1, patients with OSAS and morning headache, apnea-hypopnea index in the REM sleep period (26.7/hour, min-max: 0-108.4/hour) was higher than those in patients without morning headache (17.8/hour, min-max: 0-107.8/hour). The minimum oxygen saturation in REM sleep period and total sleep time (TST) was lower in patients with morning headache (REM sleep period: 82%, min-max: 50-94% ; TST: 79%, min-max: 50-97%) in compared to patients without morning headache (REM sleep period: 84%, min-max: 50-93% ; TST: 81%, min-max: 50-90%). CONCLUSION: Here we demonstrated that higher apnea-hypopnea index and lower oxygen saturation in REM sleep period were associated with morning headache in patients with obstructive sleep apnea syndrome.

Chronic subdural hematoma following spinal anesthesia for cesarean section.

OBJECTIVE: Intracranial subdural hematoma after spinal anesthesia is a rare and life-threatening complication of spinal anesthesia. The most common complication of spinal anesthesia is the postdural puncture headache. When severe and persistent headache after spinal anesthesia occur, differential diagnosis can be explored. In this report, we aimed to evaluate a patient with persistent headache following spinal anesthesia for cesarean section in a 31-year-old woman ,and emphasize a rare complication of spinal anesthesia which is subdural hematoma.