Modern approaches to diagnostics and treatment of migraine in children

This article reviews modern approaches to diagnostics and treatment of a very common and simultaneously underestimated and often maltreated disorder in children. It is fallacious management of migraine masked behind the diagnoses such as autonomic vessel dysfunction and vascular headache here in Ukraine. This is a tremendous problem and it should be solved with appropriate information spread across the medical community. Up-to-date classification according to the International Headache Society, diagnostic criteria, differential diagnosis, investigation and treatment strategies are presented in the article. All supported data are com-pliant with guidelines of developed countries with evidence-based medicine (US, Canada, Great Britain, Japan, Australia, New Zealand) enhanced with new trials and approved methods. Migraine management is a rapidly evolving concept, where major changes were done during recent years (transcranial Deep Brain Stimulation, vagus stimulation, CGRP-receptor mono-clonal antibodies). Considering disorder incidence and its impact on life quality and the existence of options for alleviating symptoms, this information is important for physicians who work with children, especially for general practitioners, pediatrics, pediatric and adult neurologists.

Incidence of chronic rhinosinusitis in chronic headache: diagnostic criteria

<p class="abstract"><strong>Background:</strong> Chronic rhinosinusitis and vascular headache share similar signs and symptoms, which includes nasal symptoms, facial pain and headache. The aim of the study was to evaluate incidence of chronic rhinosinusitis in patient with vascular headache<span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> A group of 100 patients aged between 25-45 who presented to our OPD with complaint of headache were included in our study. Patients were assessed with rhinosinusitis disability index (RSDI) for major and minor criteria of rhinosinusitis<span lang="EN-IN">. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The criteria of the American Academy of Otolaryngology—Head and Neck Surgery were applied to diagnose 82 cases of headache attributed to chronic rhinosinusitis. </span>Out of 100 subjects who were asked to fill the rhinosinusitis disability index 70 subjects (34 men and 36 female) had functional score (F) of 0- 45, physical score (P) of 0-35 and emotional score (E) of 0-25 and total score of 0-105, whereas 12 subjects (5 men and 7 female) had functional score (F) of 0-22, physical score (P) of 0-30 and emotional score (E) of 0-20 and a total score of 0-72.</p><p class="abstract"><strong>Conclusions:</strong> Out of total 100 patients with headache (62 men and 38 female), 82 subjects (54 male and 28 female) had chronic rhinosinusitis and 18 (10 men and 8 female) had vascular headache<span lang="EN-IN">.</span></p>

The history of oxygen inhalation as a treatment for cluster headache

Overview: Oxygen has been a generally accepted treatment method for cluster headache attacks ever since Kudrow (1981) conducted a controlled trial showing that oxygen was equally or even more effective than ergotamine injections. Purpose: The aim of the present study was to provide a historical perspective of oxygen treatment in cluster headache and to find the origin of this treatment. Oxygen for cluster headache was first described by Horton in 1952 and for migraine patients in 1940 by Alvarez. At the time, neither of the authors provided any reason why they chose for this treatment method. The vasoconstrictive effect of oxygen was not described by Horton until 1961. Conclusion: We suggest that these authors originally adhered to the vasoconstrictive theory of vascular headache that was prevalent in the early 20th century until Wolff demonstrated the contrary in the late 1930s. The early literature describes an analogy between angina pectoris and migraine, as both being due to vasoconstriction. As oxygen was described as a treatment for angina pectoris, this may be the reason why oxygen was tried for migraine and cluster headache at a time when they were not recognized as separate entities. Later it turned out to be more effective for cluster headache.