Reliability of assessing lifestyle and trigger factors in patients with migraine--findings from the PAMINA study.

BACKGROUND AND PURPOSE: Numerous lifestyle factors are blamed for triggering migraine attacks. The reliability of assessing these factors retrospectively is unknown. Therefore, retrospective and prospective assessments of lifestyle in general and of migraine triggers in particular were compared in patients with migraine. METHODS: At baseline, the patients filled in two questionnaires covering the previous 90 days. Thereafter they kept a prospective 90-day diary. Questionnaires and diary included the same set of 45 factors. In the first questionnaire the patients assessed their lifestyle, in the second they rated for each factor the likelihood of triggering a migraine attack, and in the diary they recorded the daily presence of these factors irrespective of headache. Five categories were used for comparing frequencies in questionnaire and diary, defining agreement as identical categories in diary and questionnaire, minor disagreement and major disagreement as overestimation or underestimation by one category and two or more categories, respectively. RESULTS: In all, 327 patients (283 women, age 41.9 ± 12.1 years) who recorded 28,325 patient days were included. Calculating for each factor the percentage of patients with major disagreement the mean proportion was larger for trigger factors than for lifestyle (38.7% ± 6.6% vs. 16.9% ± 6.4%, P < 0.001). The proportion of factors showing major disagreement in more than 20% of the patients was 8.8% for lifestyle but 94.1% for trigger factors (P < 0.001). CONCLUSION: Comparing questionnaire and diary assessments of lifestyle and trigger factors in patients with migraine shows that questionnaire assessment of lifestyle is reliable, whereas trigger factors are overestimated and/or underestimated in retrospective questionnaires.

Visualization of the Long Thoracic Nerve using High-Resolution Sonography.

PURPOSE: The long thoracic nerve (LTN) innervates the serratus anterior muscle (SA) which plays an important role in shoulder function. Evaluation of the LTN has so far been restricted to clinical assessment and partly electromyography and neurography. Progress of high-resolution ultrasound (HRUS) increasingly enables visualization of small peripheral nerves and their pathologies. We therefore aimed at (a) clarifying the possibility of visualization of the LTN from its origin to the most distal point in the supraclavicular region visible and (b) developing an ultrasound protocol for routine use. We further present two cases of patients with LTN pathology. METHODS: The study consisted of two parts: Part 1 included 4 non-enbalmed human bodies in whom the LTN (n = 8) was located and then marked by ink injection. Correct identification was confirmed by anatomical dissection. Part 2 included 20 healthy volunteers whose LTN (n = 40) was assessed independently by two radiologists. Identification of the LTN was defined as consensus in recorded images. RESULTS: LTN was clearly visible in all anatomical specimens and volunteers using HRUS and could be followed until the second slip of the serratus anterior muscle from the supraclavicular region. In anatomical specimens, dissection confirmed HRUS findings. For all volunteers, consensus was obtained. The mean nerve diameter was 1.6 mm ±â€Š0.3 (range 1.1 - 2.1 mm) after the formation of the main trunk. DISCUSSION: We hereby confirm a reliable possibility of visualization of the LTN in anatomical specimens as well as in volunteers. We encourage HRUS of the LTN to be part of the diagnostic work-up in patients presenting with scapular winging, shoulder weakness or pain of unknown origin.

High-Resolution Ultrasound for Diagnostic Assessment of the Great Auricular Nerve--Normal and First Pathologic Findings.

PURPOSE: The great auricular nerve (GAN) is a sensory branch of the superficial cervical plexus. While its blockade is an established procedure, little is known about the ultrasound appearance of pathologic conditions of the GAN itself. We, therefore, aimed to evaluate the possibility of the visualization and diagnostic assessment of the GAN along its entire course by means of high-resolution ultrasound (HRUS). MATERIALS AND METHODS: To assess the feasibility of visualization, we performed HRUS with an 18 MHz probe, HRUS-guided, fine-needle ink markings and consecutive dissection in six anatomical specimens. Then, we measured the diameter of the GAN in healthy volunteers and finally performed a retrospective review of patients referred for HRUS examinations because of pain within GAN territory between August 1, 2012 and August 1, 2013. RESULTS: The GAN was clearly visible with HRUS from its formation to the final branches, and was marked successfully on both sides in all anatomical specimens (n = 12). The mean average in-vivo was 0.14 cm ± 0.03 (range 0.08-0.2). Seven cases of patients with GAN pathologies of various origins (idiopathic, traumatic, tumorous and iatrogenic) were identified, of which 6 were visible on HRUS and all of which could be confirmed by complete resolution of symptoms after selective HRUS-guided GAN block. CONCLUSION: This study confirms the reliable ability to visualize the GAN with HRUS throughout its course, both in anatomical specimens and in vivo. The provided cases show that pathologies of the GAN seem to have a variety of causes and may not be rare. We, therefore, encourage the use of HRUS in patients with unclear pain in the auricular, periauricular and posterior-lateral head.

The course of migraine-a diary study in unselected patients.

The course of disease and the predictive value of depression and anxiety in patients with migraine were prospectively examined. We recruited 393 migraineurs through articles in newspapers and performed a follow-up examination 30 months later. At baseline and follow-up, patients underwent a semistructured interview, filled out the Headache Impact Test (HIT-6), Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS) and they kept a headache diary for 30 days. One hundred and fifty-one patients (38.6%) were seen at follow-up. The baseline data of patients with and without follow-up were comparable. At follow-up the number of headache days per month had decreased from 9.6 +/- 5.8 to 8.1 +/- 6.3 (P < 0.001) and the proportion of patients with chronic headache (15.4%) and medication overuse (13%) had remained stable. SDS and SAS scores were associated with a high migraine frequency and high initial SDS scores predicted high migraine frequency at follow-up. This longitudinal study in unselected patients with migraine not excluding subjects with chronic headache, medication overuse, depression or anxiety does not point towards migraine as a progressive disease in the vast majority of patients and confirms the importance of psychiatric comorbidity.