[Sleep disorders in patients with medication-overuse headache]. / Narusheniya sna u bol'nykh s lekarstvenno-indutsirovannoi golovnoi bol'yu.

OBJECTIVE: To analyze complaints about sleep disorders and assess the incidence of various sleep disorders, using relevant scales, in patients with medication-overuse headache (MOH) in comparison with patients without MOH. MATERIAL AND METHODS: The prospective case-control study included 171 patients, aged 18 years and older, with MOH (main group), and173 patients with primary headaches without MOH (control group). A neurologist conducted an initial examination and professional interview before the start of treatment. To diagnose sleep disorders, the International Classification of Sleep Disorders (3rd edition, 2014) was used. Additionally, an assessment was made using the Insomnia Severity Index Scale, the Epworth Sleepiness Scale (ESS) and the Lausanne Obstructive Sleep Apnea Syndrome Scale (NoSAS). RESULTS: Statistically significant differences were revealed in the prevalence of the following complaints about sleep disorders in patients with MOH: lack of sleep (51.5%), frequent awakenings during sleep (43.3%), discomfort in legs before falling asleep or at rest in the evening (37.4%). Difficulties falling asleep occurred equally often in both patients with MOH (43.9%) and without MOH (37.0%), as well as daytime sleepiness (40.4% vs 36.4%) and the presence of snoring (13% of patients in each group). Patients with MOH were significantly more likely to suffer from chronic insomnia (60.2% and 47.4%, respectively, p=0.02; OR 1.7; 95% CI 1.1-2.6) and restless legs syndrome (37.4% and 22.0%, respectively, p=0.002; OR 2.1; 95% CI 1.3-3.4). The incidence of hypersomnia and obstructive sleep apnea syndrome did not have statistically significant differences. CONCLUSION: Patients with MOH compared to patients without MOH have a significantly higher incidence of main complaints of sleep disorders, chronic insomnia and restless legs syndrome, which indicates the importance of sleep disorders in the pathogenesis of medication-overuse headaches and requires timely diagnosis and treatment to prevent the progression of both headaches and sleep disorders.

[An analysis of complaints about sleep disorders as an indicator of poor sleep quality in patients with primary headache disorders]. / Analiz zhalob na narusheniya sna kak indikator nizkogo kachestva sna u bol'nykh s pervichnymi golovnymi bolyami.

OBJECTIVE: To assess the prevalence of various complaints indicating poor sleep quality and its disturbances in men and women with primary headaches. MATERIAL AND METHODS: In total 305 patients (mean age 45 years, age range 18-89 years) with primary headache disorders and complaints of poor quality of sleep were included in the study. Women prevailed among these patients (79%). The average age of men (41.6) and women (45.8) had no statistically significant differences (p=0.8). The initial examination and professional face-to-face interview were initially conducted by an experienced neurologist specializing in the treatment of headaches. Within a week after that, before the start of treatment, patients were interviewed by telephone using standardized questionnaires by specially trained students and physicians. RESULTS: A frequent occurrence of many complaints of sleep disturbances were found in primary headache disorders, both in men and women, they included daytime sleepiness (75.7%), lack of sleep (69.2%), difficulty in falling asleep (57.4%), sleep disruption (51.5%), early morning awakening (47.5%), snoring (18.7%). We found the predominance of these complaints in people over 50 years old. Women had these complaints more frequently than men, besides we determined sex differences in the prevalence of these complaints. CONCLUSION: Complaints about poor sleep quality are quite common in patients with primary headache disorders and have sex and age differences. Identification of the described complaints of poor sleep quality is a simple tool for the initial analysis of sleep disorders in the practice of any specialist. We recommend paying great attention to these complaints for further diagnostics of sleep disorders and their timely treatment.

[Diagnosis and treatment of migraine: Recommendations of the Russian experts]. / Diagnostika i lechenie migreni: rekomendatsii rossiiskikh ékspertov.

These recommendations on the diagnosis and treatment of migraine were elaborated by Russian headache experts in accordance with the evidence-based practice. Together with the latest classification, diagnostic principles and criteria of different clinical sub-forms the consensus contains basic data on migraine epidemiology, pathophysiological mechanisms, differential diagnosis and most effective and evidence based approaches to pharmacological and non-pharmacological management of migraine patients.

Remission of migraine after clipping of saccular intracranial aneurysms.

BACKGROUND: Unruptured saccular intracranial aneurysm (SIA) is associated with an increased prevalence of migraine, but it is unclear whether this is altered by clipping of the aneurysm. The aim of our study was to determine whether remission rate of migraine and other recurrent headaches was greater in patients with SIA after clipping than in controls. METHODS: We prospectively studied 87 SIA patients with migraine or other recurrent headaches. They were interviewed about headaches in the preceding year before and 1 year after clipping using a validated semi-structured neurologist conducted interview. The remission rates of migraine and tension-type headache (TTH) in these patients were compared to 92 patients from a headache center. Diagnoses were made according to the ICHD-2. RESULTS: During 1 year preceding rupture 51 patients with SIA had migraine. During the year after clipping, this was reduced by 74.5% (P < 0.0001). At first encounter, 47 control patients had migraine during the preceding year, and during 1 year of treatment, it was 41, a reduction 12.8% (P > 0.5). The decrease of migraine in SIA patients was significantly higher than in controls: 74.5% vs 12.8% (P < 0.001). A history of TTH was given by 33 patients with SIA during the year preceding rupture and by 44 during 1 year after clipping (P > 0.75). Forty-one control patients had TTH, 27 after 1 year of treatment, a reduction 34.1% (P < 0.05). No factors except clipping of the aneurysm could explain the remission of migraine. CONCLUSIONS: Migraine prevalence in patients with SIA decreases significantly after clipping. Further comparative studies of migraine after coiling vs clipping in SIA patients are needed.

Systemic connective tissue abnormalities in patients with saccular intracranial aneurysms.

OBJECTIVES: Our purpose was to identify the incidence and significance of markers of systemic connective tissue abnormalities (CTA) in patients with saccular intracranial aneurysms (SIA). MATERIALS AND METHODS: This prospective case-control study included 199 consecutive patients with SIA (103 women and 96 men, mean age - 43.2 years) and 194 control patients - blood donors (108 - men, 86 - women, mean age - 38.4 years). Aneurysms were verified by conventional cerebral angiography. All patients were examined by the first author using a specially designed questionnaire and a standardized physical examination with special emphasis on systemic CTA. RESULTS: Twelve markers of systemic CTA were significantly higher in patients with SIA than in controls: visible vessels on face and chest (59.8%), scoliosis (44.7%), varicose veins in legs (39.7%), flatfoot (34.6%), hyperextensibility of the skin (33.6%), spontaneous epistaxis (25.6%), easy bruising (20.6%), abdominal hernia (13.6%), periodontal disease (10.5%), chest deformations (7.5%), abdominal striae (3.5%), joint hypermobility (2.5%). A blinded validation study in a subset of 43 patients showed similar results. Among patients with SIA, 125 of 199 patients (62.8%) had at least three markers of systemic CTA compared with 23 (11.8%) of the controls (P < 0.0001, OR = 12.5, 95% CI 7.45-21.1). The mean number of markers of systemic CTA in patients with SIA was 3.07 and 1.17 in controls. CONCLUSION: Patients with SIA have multiple markers of systemic connective tissue abnormalities. Systemic weakness of connective tissue represents a risk factor for development of SIA. Identification of these markers may help in detection of high-risk patients.

[Vascular diseases in first-degree relatives of patients with intracranial aneurysms].

An aim of the study was to compare frequencies of vascular diseases in first-degree relatives (FDR) of patients with intracranial aneurysms (IA) and FDR of controls. Pedigrees have been selected through interviews in 194 patients with IA (96 men and 98 women) and in 193 age- and sex-matched controls. Only FDR with complete information about their disorders have been included in the study: 1011 FDR of patients with IA and 812 controls. The frequency of strokes was 2.5 times and hemorrhages --3.7 times higher in FDR of patients with IA compared to controls. Only 0.9% of FDR of patients with IA had the rupture of intracranial aneurysm. The frequency of headaches was 2.8 times, ischemic heart disease--2.7 times and arterial hypertension --2 times greater in FDR of patients with IA compared to controls. Moreover, sudden death occurred 5.8 times more often in FDR of patients with IA. The data obtained suggest that vascular defects leading to the development of IA may be, in part, genetically determined. Prevention of stroke and cardiovascular disease is necessary for FDR of patients with IA.

[The role of angiotensin-converting enzyme and apolipoprotein E in the development of intracranial aneurysms.].

The distribution of allele and genotype frequencies of the Alu-insertion polymorphism of the angiotensin-converting enzyme (ACE) gene and missence mutations leading to the substitution of arginine to cysteine in positions 112 and 158 of apolipoprotein E (APOE) has been studied in 166 patients with brain intracranial aneurysms and in 192 controls of Russian origin from Ural region. Brain vascular aneurysms with hypertension were associated with the D*D* ACE genotype in men and with the e2 allele and the e2/e3 APOE genotype in women. The association was also observed between the e2 allele and the e2/e3 APOE genotype and family history of stroke, hemorrhages and aneurysms in patients. Men with the I*D* ACE genotype and the e4 APOE allele were at lower risk.

[Vascular pathology in first-degree relatives of patients with intracranial aneurysms].

An aim of the study was to compare by the analysis of pedigrees the frequency of vascular pathology in first-degree relatives (FDR) of patients with intracranial aneurysms (IA) and controls. Pedigrees were selected by interviewing 194 patients with IA (94 men and 100 women) and 193 age- and sex-matched control patients. Only FDR with complete information about their health status were included: 1011 FDR of patients with IA and 812 FDR of controls. The results of the study revealed that the frequency of strokes was 2.5 times higher in FDR of patients with IA than in those of controls: 6.5% and 2.6%, respectively (RR = 2.52, 95% CI = 1.56-4.09). Hemorrhages occurred 3.7 times more often in FDR of patients with IA than in FDR of controls: 3.4% versus 0.9% (RR = 3.90, 95% CI = 1.74-8.75). Only 0.9% of FDR of patients with IA had the rupture of intracranial aneurysm compared with nobody in FDR of controls. The frequency of headaches was 2.8 times greater in FDR of patients with IA than in those of controls: 19.6% versus 7.1% (RR = 2.74, 95% CI = 2.08-3.62). FDR of patients with IA suffered from arterial hypertension 2 times more often than FDR of controls: 24.9% and 11.6%, respectively (RR = 2.15, 95% CI = 1.73-2.68). Coronary heart disease was 2.7 times more frequent in FDR of patients with IA than in controls: 8.9% and 3.3%, respectively (RR = 2.68, 95% CI = 1.76-4.07). Sudden death occurred in FDR of patients with IA 5.8 times more often than FDR of controls: 11.1% and 1.9%, respectively (RR = 5.68, 95% CI = 1.37-23.39). Thus, vascular pathology occurs relatively often in FDR of patients with IA implying that vascular defects which cause the development of IA may be, at least in part, genetically determined. Prevention of stroke and cardiovascular disease is necessary for FDR of patients with IA.

[The formation of true saccular aneurysms from diverticula of the cerebral arterial walls]. / Obrazovanie istinnykh meshotchatykh anevrizm iz vypiachivanii stenok arterii mozga.

The authors show that aneurysmic diverticula of cerebral vascular walls cam grow in size and to develop, with time, into true saccular aneurysms. Cases of aneurysmic diverticula transformation into aneurysms illustrate dynamic pattern of aneurysmogenesis and formation of this pathology during life. Feasibility of the growth and rupture of the aneurysm in intracranial hemorrhage dictates necessity of follow-up visualizations of cerebral vessels in such patients (contrast angiography, NMR angiography).

[Heredity in intracranial aneurysms (a study of identical twins)]. / K voprosu o nasledstvennosti pri intrakranial'nykh anevrizmakh (issledovanie identichnykh bliznetsov).

The study of identical twins revealed an important role of hereditary factors in the development of cerebral aneurysms. The "weakness" of connective tissue, caused by some genetic (or polygenic) defects, concurrent with several acquired conditions (essential hypertension, connective tissue disorders) leads to the development and rupture of cerebral aneurysms.