A Comparative Analysis of Amytripiline, Flunnarazine and Topiramate in the treatment of Primary Headache

2021 ◽  
Vol 18 (2) ◽  
pp. 45-48
Author(s):  
Babu Ram Pokharel ◽  
Gopal Raman Sharma ◽  
Prabhaw Upadhyaya ◽  
Samip Jung Budhathoki ◽  
Santosh Thapa ◽  
...  
Keyword(s):  
Impact Test ◽  
Primary Headache ◽  
Headache Disorder ◽  
Categorical Variables ◽  
Primary Headaches ◽  
Chi Square ◽  
Headache Patient ◽  
Primary Headache Disorder ◽  
Chi Square Test ◽  
Headache Impact

Introduction Primary headache disorder, characterized by recurrent headache is the most prevalent disease leading to widespread ill health and impaired quality of life. In Nepal headache is one of the most common cause of patient attending neurology clinic. Amitriptyline, Flunarizine and Topiramate are common drugs in the treatment of primary headache. We conducted this study to compare the efficacy of drugs namely Amitriptyline, Flunarizine and Topiramate in the treatment of primary headache Materials and Methods This is the retrospective data analysis of primary headache patient treated with amitriptyline, flunarizine and topiramate. On their first, second and third subsequent visits, Headache Impact Test 6 Scoring was done by a medical person. Patient were treated clinically. After third follow up data were analyzed using SPSS version 20.0. Categorical variables were compared by chi-square test, paired sample t-test, ANOVA test and Welch test. Results A total of 142 patient data was analyzed. The most common age group were between 20 to 39 years (56.34%) followed by 40 to 59 years (33.80%). Female were predominant in the group 124 (87.32%).  All three medication Amitriptyline, Flunarizine and Topiramate were able to significantly lower Headache impact test  -17.23 ± 6.643, -14.06 ± 7.155, -15.82 ± 5.907 respectively (P- <0.001). Amitriptyline was found to be better than other two drugs in reducing Headache Impact Test. Conclusion All three drugs namely Amitriptyline, Flunarizine and Topiramate, are significantly effective in the treatment of primary headache. Though tension type of headache is the most common type of headache, amitriptyline seems to be equally effective in treatment with other primary headaches.

scholarly journals Failure to identify underlying autoimmunity and primary headache disorder might be the reasons for refractoriness of trochlear headaches

2020 ◽  
Vol 3 ◽  
pp. 251581632095177
Author(s):  
Pawan Ojha ◽  
Vikram Aglave ◽  
Suranjana Basak ◽  
Jayendra Yadav
Keyword(s):  
Primary Headache ◽  
Headache Disorder ◽  
Tension Type Headache ◽  
Prior History ◽  
Primary Headaches ◽  
Primary Headache Disorder ◽  
Local Injections ◽  
Poor Outcomes ◽  
Type Headache ◽  
A Minor

Introduction: A better understanding of etiology might improve poor outcomes of trochlear headaches (TRHs). Aims: To study clinical spectrum, etiology, and therapeutic response of TRH. Methods: Fifty-three TRH patients seen in a single center between 2015 and 2020 were included, excluding Trigeminal Autonomic Cephalalgia (TAC). Results: Mean age was 36.45 years (range 11–85 years), with 77.35% being females. Twenty-five patients had continuous trochlear headache (CTRH) and 28 episodic trochlear headache (ETRH). Tension-type headache (TTH) occurred in 9 ETRH patients and 24 of 25 CTRH patients, and migraine-like headaches occurred in 19 ETRH patients and 8 CTRH (trochlear migraine) patients. Prior history of headaches was noted in 22 of 28 ETRH and 11 of 25 CTRH patients. Twenty-eight responded to migraine/TTH prophylaxis, 25 being nonresponders (partial/no response). Fourteen of 25 nonresponders, 4 of 28 responders (4 of 4 secondary and 5 of 9 idiopathic trochleitis (IT), 3 of 9 primary TRH (PTRH), and 6 of 28 ETRH) had autoantibodies, that is, 11 antinuclear antibodies (ANAs) and 7 antithyroid antibodies. Ten of 14 (71.42%) antibody-positive nonresponders improved with immunosuppressants including steroids/hydroxychloroquine and only 11 required local injections. Finally, 38 patients had good response, 13 partial, and 2 no response. The etiology and refractoriness of IT can be attributed to underlying autoimmunity and a minor contribution by primary headaches, vice versa being the case for PTRH and ETRH. Refractory TRHs should be evaluated for underlying autoimmunity and primary headaches. Conclusion: Identification and treatment of underlying autoimmunity and primary headaches can help improve outcome of TRH.

Prevalence of Primary Headache Disorders in Kuwait

2017 ◽  
Vol 48 (3-4) ◽  
pp. 138-146 ◽  
Author(s):  
Jasem Yousef Al-Hashel ◽  
Samar Farouk Ahmed ◽  
Raed Alroughani
Keyword(s):  
Medication Overuse Headache ◽  
Primary Headache ◽  
Headache Disorder ◽  
Episodic Migraine ◽  
Tension Type Headache ◽  
Primary Headaches ◽  
Primary Headache Disorder ◽  
Work Related ◽  
Primary Headache Disorders ◽  
Kuwaiti Population

Background: Only an insignificant quantum of data exists on the prevalence of primary headaches among those living in Kuwait. We aimed to determine the prevalence of primary headaches among the Kuwaiti population. Methods: This community-based study included Kuwaiti population aged 18-65 years. Using systematic random sampling, data was collected by the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation questionnaire. Responses to the diagnostic questions were transformed into diagnoses algorithmically to confirm the diagnosis of primary headache. Results: A total of 15,523 patients were identified of whom 9,527 (61%) were diagnosed with primary headache disorder; a female predominance of 62.2% was observed. The mean age was 34.84 ± 10.19. Tension-type headache (TTH) was the most prevalent at 29% followed by episodic migraine (23.11%), chronic migraine (5.4%), and medication overuse headache (2.4%). Primary headache prevalence declined steadily from 71% in those aged 18-30 years to 23% in those over 50 (p < 0. 037). The female:male ratio was 1.7:1. Frequency and severity of primary headache were correlated significantly with lost work days (r = 0.611, p < 0.001 and r = 0.102, p = 0.001, respectively). Conclusions. In Kuwait, primary headache disorder is more frequent in young adults and females. TTH followed by episodic migraine were the more prevalent types of headache. Higher frequency and severe headaches were associated with increasing social and work-related burden.

Pathophysiology of hypnic headache

Cephalalgia ◽  
2014 ◽  
Vol 34 (10) ◽  
pp. 806-812 ◽  
Author(s):  
Dagny Holle ◽  
Steffen Naegel ◽  
Mark Obermann
Keyword(s):  
Electrophysiological Study ◽  
Primary Headache ◽  
Headache Disorder ◽  
Primary Headaches ◽  
Hypnic Headache ◽  
Primary Headache Disorder ◽  
Study Results ◽  
Symptomatic Headache ◽  
Underlying Mechanisms ◽  
Underlying Pathophysiology

Background Hypnic headache (HH) is a rare primary headache disorder that is characterized by strictly sleep related headache attacks. Purpose The underlying pathophysiology of HH is mainly enigmatic but some clinical characteristics such as circadian rhythmicity and caffeine responsiveness may point toward possible underlying mechanisms. Method Current studies that deal with the pathophysiology of HH are summarized. Data on cerebral imaging, sleep, electrophysiology studies, effectiveness of drugs, and symptomatic headache types are discussed to illuminate underlying pathophysiologic mechanisms. Conclusion HH can be clearly differentiated by its clinical presentation as well as imaging and electrophysiological study results from other primary headaches such as migraine or cluster headache. The underlying pathophysiology is still enigmatic but a hypothalamic involvement seems to be likely.

scholarly journals Evidence That HFE H63D Variant Is a Potential Disease Modifier in Cluster Headache

2021 ◽  
Author(s):  
Maria Papasavva ◽  
Michail Vikelis ◽  
Martha-Spyridoula Katsarou ◽  
Vasileios Siokas ◽  
Emmanouil Dermitzakis ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Iron Homeostasis ◽  
Hereditary Hemochromatosis ◽  
Primary Headache ◽  
Headache Disorder ◽  
Allelic Frequency ◽  
Primary Headaches ◽  
Primary Headache Disorder ◽  
Disease Modifier ◽  
Potential Link

AbstractCluster headache (CH) is a primary headache disorder with a complex genetic background. Several studies indicate a potential link between iron homeostasis and the pathophysiology of primary headaches. The HFE gene encodes for a protein involved in iron metabolism, while genetic variants in HFE have been associated with hereditary hemochromatosis (HH), an iron overload disorder. The objective of the current study was to examine the association of the more common HFE H63D variant, with the susceptibility to develop CH and diverse clinical phenotypes in a population of Southeastern European Caucasian (SEC) origin. Genomic DNA samples from 128 CH patients and 294 neurologically healthy controls were genotyped for the HFE rs1799945 (H63D) variant. H63D genotypic and allelic frequency distribution did not differ significantly between patients and controls (p > 0.05). Subgroup analysis revealed a significantly more frequent occurrence of the variant G allele in chronic compared to episodic CH patients, indicative for a possible correlation of the HFE gene with the susceptibility for disease chronification. Although homozygosity for the less prevalent H63D variant G allele was minimal in the CH cohort, the results of the present study are in accordance with previous studies in CH and migraine patients, suggesting that HFE H63D variant modifies the disease clinical characteristics. Hence, despite the absence of a per se association with CH susceptibility in the current SEC cohort, variability in HFE gene may be potentially regarded as a disease modifier genetic factor in CH.

scholarly journals Impact of Primary Headache Disorder on Quality of Life Among School students in Kuwait

2020 ◽  
Author(s):  
Jasem Yousef Al-Hashel ◽  
Raed Alroughani ◽  
Sameera Shuaibi ◽  
Abdelrahman AlAshqar ◽  
Fajer AlHamdan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Middle School Students ◽  
Primary Headache ◽  
Headache Disorder ◽  
Primary Headaches ◽  
Headache Disorders ◽  
School Students ◽  
Primary Headache Disorder ◽  
Primary Headache Disorders

Abstract Background Primary headache disorders have being increasingly reported in younger populations. They can have significant effects on their quality of life and academic achievement and may cause significant distress to their families. Aims and Objectives To assess the burden of primary headache disorder and its impact on the quality of life on school student in Kuwait. Methods A cross-sectional study was conducted among Kuwaiti primary and middle school students of both genders in randomly selected schools located in two governorates in 2018/2019 academic year. Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire for children and adolescents was used to assess the impact of primary headaches on the quality of life. Results 1091 questionnaires were completed by primary and middle school students of both genders; of whom 466 students (girls 321 (68.88%) were diagnosed with primary headache disorders with mean age 11.98 + 2.03 years. In the month prior to the survey, the effect of the headache was variable. The students lost a mean of 1.99 + 2.015 days of school while they could not perform their usual activities for a mean of 2.84 + 4.28 days. Their parents lost a mean of 2 + 2.03 days of work because of headaches of their children and parents prohibited 5.7% of the students to engage in any activity due to their headaches. Difficulties in concentrations were reported as never sometimes (39.1%), often (24.8%), and always (26%). Majority of the students (?%) experienced a feeling of sadness ranging from sometimes to always. Most of the students (?%) struggled to cope with the headache and 22.4% were never able to cope. Additionally, 19.4% of students reported they did not want others noticing their headache. Conclusion Primary headache disorder can have a significant impact on the quality of life in children. It can affect their engagement in activities and academic achievement. Implementing strategies to properly manage schoolchildren with primary headaches can have profound effects on their quality of life.

scholarly journals Effectiveness of paranasal air suction on acute migraine using portable air sucker – a randomized, double blind study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
S. M. R. Bandara ◽  
S. Samita ◽  
A. M. Kiridana ◽  
H. M. M. T. B. Herath
Keyword(s):  
Clinical Trial ◽  
Side Effects ◽  
Sri Lanka ◽  
Primary Headache ◽  
Headache Disorder ◽  
Low Pressure ◽  
Outcome Variable ◽  
Double Blind ◽  
Primary Headache Disorder ◽  
Before And After

Abstract Background Migraine is a primary headache disorder and is the most common disabling primary headache disorder that occurs in children and adolescents. A recent study showed that paranasal air suction can provide relief to migraine headache. However, in order to get the maximum benefit out of it, an easy to use effective air sucker should be available. Aiming to fulfil the above requirement, a randomized, double blind control clinical trial was conducted to investigate the efficacy of a recently developed low–pressure portable air sucker. Methods Eighty-six Sri Lankan school children of age 16–19 years with migraine were enrolled for the study. They were randomly allocated into two groups, and one group was subjected to six intermittent ten-second paranasal air suctions using the portable air sucker for 120 s. The other group was subjected to placebo air suction (no paranasal air suction). The effect of suction using portable air sucker was the primary objective but side of headache, type of headache, and gender were also studied as source variables. The primary response studied was severity of headache. In addition, left and right supraorbital tenderness, photophobia, phonophobia, numbness over the face and scalp, nausea and generalized tiredness/weakness of the body were studied. The measurements on all those variables were made before and after suction, and the statistical analysis was performed based on before and after differences. As a follow–up, patients were monitored for 24-h period. Results There was a significant reduction in the severity of headache pain (OR = 25.98, P < 0.0001), which was the primary outcome variable, and other migraine symptoms studied, tenderness (left) (OR = 289.69, P < 0.0001), tenderness (right) (OR > 267.17, P < 0.0001), photophobia (OR = 2115.6, P < 0.0001), phonophobia (OR > 12.62, P < 0.0001) nausea (OR > 515.59, P < 0.0001) and weakness (OR = 549.06, P < 0.0001) except for numbness (OR = 0.747, P = 0.67) in the treatment group compared to the control group 2 min after the suction. These symptoms did not recur within 24-h period and there were no significant side effects recorded during the 24-h observation period. Conclusion This pilot study showed that low–pressure portable air sucker is effective in paranasal air suction, and suction for 120 s using the sucker can provide an immediate relief which can last for more than 24-h period without any side effects. Trail registration Clinical Trial Government Identification Number – 1548/2016. Ethical Clearance Granted Institute – Medical Research Institute, Colombo, Sri Lanka (No 38/2016). Sri Lanka Clinical Trial Registration No: SLCTR/2017/018. Date of registration = 29/ 06/2017. Approval Granting Organization to use the device in the clinical trial– National Medicines Regulatory Authority Sri Lanka (16 Jan 2018), The device won award at Geneva international inventers exhibition in 2016 and President award in 2018 in Sri Lanka. It is a patented device in Sri Lanka and patent number was SLKP/1/18295. All methods were carried out in accordance with CONSORT 2010 guidelines.

scholarly journals 350. Neurocysticercosis – Gender Differences in Clinical Presentations

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S244-S244
Author(s):  
Bharath Pendyala ◽  
Prasanth Lingamaneni ◽  
Patricia DeMarais ◽  
Lakshmi Warrior ◽  
Gregory Huhn
Keyword(s):  
Gender Differences ◽  
Categorical Variables ◽  
Public Health Issue ◽  
Diagnostic Code ◽  
Continuous Variables ◽  
Chi Square ◽  
Generalized Seizures ◽  
Icd 10 ◽  
Chi Square Test ◽  
Reported Data

Abstract Background Neurocysticercosis is a Neglected Tropical Disease and an important public health issue. Our goal was to collect and analyze data regarding clinically significant gender differences among our Neurocysticercosis patients. Methods A retrospective chart search with ICD 9/ ICD 10 diagnostic code for Neurocysticercosis and neuroimaging suggestive of Neurocysticercosis was performed for clinical encounters in the hospital or affiliated clinics between years 2013–2018. After a careful chart review, patients who were clinically diagnosed with Neurocysticercosis were included in the study. T-test was used to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Results Among 90 total patients included, male (49.4%) and female (50.6%) distribution were nearly identical. The mean age in females was found to be higher than males (52.5 vs 42.0, P &lt; 0.0001). Almost an equal number of males and females presented with either seizures (63.6% vs 57.8%, P= 0.85), headaches (25.0% vs 28.9%, p= 0.85), or other symptoms (11.4% vs 13.3%, p= 0.85). Males had more generalized seizures compared to females (60% vs 38%, P= 0.37), although this result was not statistically significant. Females were more likely to present with &gt; 1 lesion (82.2% vs 56.8%, P= 0.01). Males were more likely to have cystic lesions (64.7% vs 27.9%, P &lt; 0.001) compared to females who had more calcified lesions on presentation (65.1% vs 20.6%, P &lt; 0.001). Male patients were more likely to have contrast enhancement or edema surrounding the lesions (61.4% vs 33.3%, P= 0.01) and were more likely to require treatment with Albendazole/Praziquantel (75.8% vs 31.7%, P &lt; 0.001). Conclusion Although previously reported data is limited, there is a suggestion that there are gender differences in host immune response and that inflammation surrounding parenchymal lesions is more intense in females. This study suggests that men either present early in the disease phase or have different immune responses than women and require anti-parasitic therapy more frequently. More research in this aspect is needed. Disclosures All Authors: No reported disclosures

scholarly journals Diagnosis and management of migraine in ten steps

2021 ◽  
Author(s):  
Anna K. Eigenbrodt ◽  
Håkan Ashina ◽  
Sabrina Khan ◽  
Hans-Christoph Diener ◽  
Dimos D. Mitsikostas ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Consensus Statement ◽  
Preventive Treatment ◽  
Primary Headache ◽  
Headache Disorder ◽  
Clinical Decision ◽  
Diagnosis And Management ◽  
Primary Headache Disorder ◽  
Management Of Complications ◽  
European Headache Federation

AbstractMigraine is a disabling primary headache disorder that directly affects more than one billion people worldwide. Despite its widespread prevalence, migraine remains under-diagnosed and under-treated. To support clinical decision-making, we convened a European panel of experts to develop a ten-step approach to the diagnosis and management of migraine. Each step was established by expert consensus and supported by a review of current literature, and the Consensus Statement is endorsed by the European Headache Federation and the European Academy of Neurology. In this Consensus Statement, we introduce typical clinical features, diagnostic criteria and differential diagnoses of migraine. We then emphasize the value of patient centricity and patient education to ensure treatment adherence and satisfaction with care provision. Further, we outline best practices for acute and preventive treatment of migraine in various patient populations, including adults, children and adolescents, pregnant and breastfeeding women, and older people. In addition, we provide recommendations for evaluating treatment response and managing treatment failure. Lastly, we discuss the management of complications and comorbidities as well as the importance of planning long-term follow-up.

Abstract 56: Acute Stroke Reperfusion Treatment Rates at NIH StrokeNET Hospitals

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Opeolu Adeoye ◽  
Dawn Kleindorfer
Keyword(s):  
Clinical Trials ◽  
High Volume ◽  
The United States ◽  
Primary Diagnosis ◽  
Categorical Variables ◽  
Phase 3 ◽  
Chi Square ◽  
Successful Recruitment ◽  
Chi Square Test ◽  
Reperfusion Phase

Background: In 2013, the NIH Stroke Trials Network (StrokeNET) was established to maximize efficiencies in stroke clinical trials. Successful recruitment in future trials was required for participating sites. A high volume of cases treated is a surrogate for the potential to recruit. Among Medicare-eligible acute ischemic stroke (AIS) cases, we estimated the IV rt-PA and endovascular embolectomy treatment rates at StrokeNET Regional Coordinating Centers and their partner hospitals compared with non-StrokeNET hospitals in the United States (US). Methods: We used demographics and IV rt-PA and embolectomy rates in the 2013 Medicare Provider and Analysis Review (MEDPAR) dataset. ICD-9 codes 433.xx, 434.xx and 436 identified AIS cases. ICD-9 code 99.10 defined rt-PA treatment and ICD-9 code 39.74 defined embolectomy. Demographics and treatment rates at StrokeNET and non-StrokeNET sites were compared using t-test for proportions and Chi-square test for categorical variables as appropriate. Results: Of 386,157 AIS primary diagnosis discharges, 5.1% received IV rt-PA and 0.8% had embolectomy (Table). By June 6, 2014, StrokeNET comprised 247 acute care hospitals that discharged 48,946 (13%) out of 386,157 AIS cases. rt-PA (7.4% vs 4.8%) and embolectomy (1.9% vs 0.6%) treatment rates were higher at StrokeNET hospitals. In 2013, 36% of StrokeNET hospitals treated more than 20 AIS cases with rt-PA or embolectomy compared with 6% of non-StrokeNET hospitals (P<0.0001).Conclusions StrokeNET hospitals treat more AIS cases with acute reperfusion therapies. Thus, StrokeNET could successfully recruit in acute reperfusion clinical trials depending on study size, capture of eligible patients and the number of competing trials. We likely underestimated treatment rates due to not accounting for drip-and-ship and non-Medicare cases. To further enhance enrollments in large acute reperfusion phase 3 trials, partnership with high volume non-StrokeNET hospitals may be warranted.

scholarly journals Relationship Between Undernutrition and Periodontal Diseases Among Yemen Population: a Cross-sectional Study

2020 ◽  
Author(s):  
Milad Al-kalisi ◽  
Manal Al-Hajri ◽  
Sarah Al-Rai
Keyword(s):  
Periodontal Diseases ◽  
Cross Sectional Study ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Mean Values ◽  
Khat Chewing ◽  
Chi Square Test

Abstract Background: Undernutrition is an inadequate supply of energy and nutrients. Periodontal diseases (PDs) defined as a broad form of chronic inflammatory diseases of the gingiva, bone and ligaments supporting the teeth. This study aimed to reveal the effect of undernutrition, using body mass index (BMI) and serum albumin level (Alb) on PDs and other risk factors as age, smoking and khat chewing. Methods: This was a cross-sectional study conducted at the faculty of dentistry, Sana’a University. Of 1920 patients attended to clinics, only 229 matched the study criteria. Oral examination was performed to assess the periodontal clinical parameters measurements. BMI and Alb was measured. Statistical analysis was used to present the association between categorical variables was assessed using Chi square test and Fisher-Exact test. ANOVA was used to assess the differences in the mean values of the quantitative outcomes. Chi square test was used to evaluate the association between BMI and age, gender, occupation, education level, smoking, khat chewing as well as BMI with PDs. Results: Most of participants (58.5%) were males and most of the study sample (91.3%) was at the age group of (18-35). Among all subjects, (81.2%) of cases were diagnosed with gingivitis. (60.7%) of study participants were mildly undernourished according to BMI. (93%) of participants showed normal Alb level. Regarding to habits, only (18.2%) of patients were smokers and more than half of participants (59.4%) were khat chewers. Conclusion: There was a relationship between PDs and undernutrition which was obviously seen between gingivitis and mild undernutrition.

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