Efficacy of conservative physiotherapeutic approaches in hormonal-related headaches: a scoping review protocol.

ABSTRACT Introduction. Headache is one of the most common and disabling conditions worldwide, as described by the World Health Organization report. The risk of suffering from headache has been described to increase from twofold to threefold in adult women compared to men, depending on the studies. These gender differences have been linked to environmental, genetic, epigenetic, and hormonal aspects. Sex hormones can enhance headaches mainly through sensitization of the trigemino-vascular system and modulation of the blood vessel factors, with significant clinical consequences. International guidelines suggest several pharmacological and non-pharmacological treatments in the management of headache disorders as acute or preventive therapies. Few studies have been conducted on the efficacy and effectiveness of therapies in managing hormonal-related headaches to date. Therefore, this scoping review (ScR) aims to summarize the evidence regarding the efficacy of conservative physiotherapeutic approaches on this topic in the domain of gender medicine, which studies sex influences on pathophysiology, clinical signs, prevention, and therapy of diseases. Methods and analysis. The ScR will be performed following the 6-stage methodology suggested by Arksey and O Malley and the extensions to the original framework recommended by the Joanna Briggs Institute. MEDLINE, Cochrane Central, Scopus, CINHAL, Embase and PEDro databases will be searched. Additional records will be identified through searching in grey literature and the reference lists of all relevant studies. No study design, publication type, language nor date restrictions will be applied. Two reviewers will independently screen all abstracts and full-text studies for inclusion. The research team will develop a data collection form to extract the studies characteristics. A tabular and accompanying narrative summary of the information will be provided. This protocol received input from all authors who have expertise in research methodology and specific knowledge in the field. Ethics and dissemination. This study does not require ethical approval as we will not collect personal data. It will summarize information from publicly available studies in line with the nature of the study s methodology. Regarding dissemination activities, the results of this review will be submitted for publication in a peer-reviewed journal, presented at relevant conferences in the field and disseminated through working groups, webinars and partners. KEYWORDS Headache, menstruation, hormones, physical therapy, exercise therapy.

Headache in hypertension patients in young rural population of Punjab

Objectives; To find the association of essential hypertension and headache in rural young population of PUNJAB, so as to treat the cases at the earliest stage . Material and Methods: The study is conducted in medical department of Pak Red Crescent Medical college Dina Nath in the period from October 2020 to June 2021 . fifty four patients including thirty three males and twenty one females with essential hypertension in age group of 18-35 were selected after scrutinizing clinically and on investigations. The patients were then differentiated as those suffering from generalized headaches without any secondary cause of headache were included Results: Total nineteen patients including seven males out of thirty three males and twelve out of twenty one females in the hypertension patients were having headache. So positivity in males was twenty one percent and in females was fifty seven percent , however in total 19/54 I e 35% were found having headache. Conclusions: All the patients with hypertension should be further evaluated for headache and it is not necessary that some secondary cause of hypertension is necessary for headache but there are many other other pathophysiological links which are still to be evaluated. Keywords: headache, hypertension.migraine, antihypertensive

Determine the Prevalence of Migraine in Pregnant Women Presented with Severe Headache

Objective: The main objective of this study is to determine the prevalence of migraine in pregnant women presented with severe headache. Study Design: Retrospective study Place and Duration: Study was conducted at department of Neurology Ayub Teaching Hospital, Abbottabad for duration of eighteen months(from August 2019 to February 2021). Methods: 120 pregnant women with ages 18-45 years were presented in this study. Patients’ detailed demographics including age, body mass index and gestational age was recorded after taking informed written consent. Patients with severe headache were enrolled and International Classification of Headache Disorders-II criteria were used for diagnosis of migraine. Trimester of pregnancy were assessed in terms of 1st, second and third. Complete date was analyzed by SPSS 20.version. Results: Mean age of the patients was 32.16±6.44 years with mean BMI 25.07±2.44 kg/m2. Most of the patients 70 (58.3%) were from third trimester. Gestational age of the pregnant women was 22.64±11.03 weeks. 75 (62.5%) were from urban areas and mostly had low socio-economic status 80 (66.7%). 45 (37.5%) women were educated. 50 (41.7%) cases diagnosed migraine, 35 (29.17%) cases had tension type headache (TTH) while the rest were showed only severe headache among pregnant women. Most common symptom was nausea 24 (48%), followed by vomiting 16 (32%) and sensitivity to light was found in 10 (20%) women. Conclusion: In this study, we concluded with the prevalent condition for pregnant women of migraine and headache-related impairment. Migraine and headache during pregnancy are critical for diagnosis and treatment. Keywords: Headache, Pregnancy, Migraine, Prevalence

THE EFFICACY OF GREATER OCCIPITAL NERVE BLOCK IN PATIENTS WITH CHRONIC MIGRAINE

Background and Purpose: In chronic migraines(CM), the rate of benefiting from medical treatment is relatively low, and it is known that patients use analgesics extensively. Greater occipital nerve (GON) block, have been started to be used in chronic migraine patients who were refractory to treatment. In this study, we aimed to evaluate the headache attack frequency, analgesic use, VAS (Visual Analog Scale) and MIDAS (Migraine Disability Assessment Scale) scores in the 3-month follow-up of patients we had performed a GON block in our clinic for chronic migraine refractory to medical treatment. Methods: A total of 120 CM patients were included in the study. The number of analgesics used, the number of days with pain, and the VAS and MIDAS scores were recorded before the GON block and at one and three months of treatment. Results: There was a statistically significant (p<0.001*) reduction in the number of days with pain, analgesic use, and the VAS and MIDAS scores in the first and third months compared to the pre-treatment baseline values in patients who had undergone a GON block. No significant differences between the first and third months. Conclusions: After the GON block, we noted a significant reduction of headaches and improved quality of life in patients who had been experiencing severe headaches despite medical treatment. The GON block has an exceptionally high benefit rate, might be considered as a treatment option before migraines gain chronicity, patients are not exposed to an excessive medical burden and increased treatment costs. Keywords: Headache; Chronic migraine; Greater occipital nerve block.