OSTEOPATHIC CORRECTION IN TREATING PATIENTS WITH TENSION HEADACHE SYMPTOM AGAINST TMJ DYSFUNCTION

Patients may have headache due to pathological issues occurring in the cervical spine and resulting in compression of the vertebral artery passing nearby. This comes along with disturbed blood supply to the brain. The aim of this study is to offer reliable grounds, and evaluate osteopathic correction when treating headache of tension (HAT) caused by a dysfunction of the temporomandibular joint (TMJ). A comprehensive examination involved 26 patients aged 18 to 65. The study outcomes allow recommending to include soft osteopathic techniques in the set of therapeutic measures. In order to make osteopathic treatment available for patients with HAT caused by the TMJ dysfunction, computed tomography (CT) of the TMJ and cranio-cervical junction is a typical choice. Given the high efficiency of the combined work of an osteopath joining effort with an orthopedic dentist and an orthodontist who has a good command of neuromuscular correction approaches, it appears a feasible option to use such combined treatment in patients with the TMJ dysfunction-caused HAT. To improve the quality of osteopathic correction and maintain the positive outcome we recommend using a supporting teeth protector — an elastopositioning corrector or TMJ trainer. This enables to decompress the TMJ.

Cardiac Cephalgia: Angina in the Head

Cardiac cephalgia is a migraine like headache that occurs during episodes of myocardial ischaemia. Although most of the patients presenting with ischaemic heart disease have chest pain, there are other rare presenting symptoms like cardiac cephalgia. Headache can be the only presentation of coronary artery disease. We report a case of a 57 years-old man, Presenting with only headache during brisk walking, Exercise Tolerance Test (ETT) was positive for Electrocardiograph (ECG) evidence of provocable myocardial ischemia, who latter was diagnosed as double vessel coronary artery diseaseon Coronary Angiogram (CAG). As the patient preferred remaining without revascularization, he was put onto optimum medical management for ischaemic heart disease. A follow up visit after one month revealed, marked improvement of the headache with anti anginal medications. Early evaluation and diagnosis of the headache symptom should be done because treatment with anti-migraine drugs may deteriorate headache and undermine the diagnosis of coronary artery disease. Bangladesh Med J. 2019 Sep; 48 (3): 46-49

Association between Childhood Allergic Diseases and Headache

Allergic disorders and headache are both common in pediatric populations. Chronic allergic disorders may affect sleep leading to chronic daily headaches. Poor controlled allergies may cause neurogenic inflammation that may be a predisposing factor to migraine headaches. We hypothesized that a higher prevalence of headaches may be found in children with allergy compared with those without allergy. Patients with either multiple allergic disorders or with poorly controlled allergic symptoms may be associated with headaches, especially migraine headaches. This study aimed to examine (1) the prevalence of headache in allergic children and (2) the association between allergic diseases and headache. Patients with allergic diseases and nonallergic children as control were recruited in the pediatric outpatient clinic of Naresuan University Hospital between January 2017 and January 2018. A neurological examination was performed by a pediatric neurologist. The questionnaire consisted of the pediatric headache symptom checklist and the items for evaluation of allergy control status. The diagnosis and classification of headache were based on the International Classification of Headache Disorders-3 criteria. The results were analyzed using the Student's t-test, chi-squared tests, odds ratios, and 95% confidence interval. One hundred fifty-five subjects were enrolled in our study, of which 85 subjects (54.8%) were diagnosed with allergic diseases. The allergic group had a significantly higher prevalence of headache than the control group (37 [43.5%] vs. 19 [27.1%], p = 0.035). The allergic group also had a significantly higher prevalence of migraine and probable migraine headache than the control group (23 [27.06%] vs. 7 [10%], p = 0.007). The prevalence of headache did not increase in subjects who had more than one allergic disease. There was no association between the control of allergy and headache. The present study showed that allergic diseases were associated with increased prevalence of headache and migraine in children. However, the control of allergic symptoms and the number of allergic diseases were not associated with headache. The physicians should be aware of headache in allergic patients and give appropriate treatment. Further study would be to identify specific biomarkers for the development of better treatment in these comorbid diseases.

Correlation of a new hydrodynamic index with other effective indexes in Chiari I malformation patients with different associations

This study aimed to find a new CSF hydrodynamic index to assess Chiari type I malformation (CM-I) patients’ conditions and examine the relationship of this new index with morphometric and volumetric changes in these patients and their clinical symptoms. To this end, 58 CM-I patients in four groups and 20 healthy subjects underwent PC-MRI. Ten morphometric and three volumetric parameters were calculated. The CSF hydrodynamic parameters were also analyzed through computational fluid dynamic (CFD) simulation. The maximum CSF pressure was identified as a new hydrodynamic parameter to assess the CM-I patients’ conditions. This parameter was similar in patients with the same symptoms regardless of the group to which they belonged. The result showed a weak correlation between the maximum CSF pressure and the morphometric parameters in the patients. Among the volumetric parameters, PCF volume had the highest correlation with the maximum CSF pressure, which its value being higher in patients with CM-I/SM/scoliosis (R2 = 65.6%, P = 0.0022) than in the other patients. PCF volume was the more relevant volumetric parameter to assess the patients’ symptoms. The values of PCF volume were greater in patients that headache symptom was more obvious than other symptoms, as compared to the other patients.

Headache is associated with aberrant cerebral blood flow in chronic tinnitus revealed by perfusion functional MRI

Background: Chronic tinnitus is often accompanied with headache symptom that will affect the cerebral blood flow (CBF) and exacerbate the tinnitus distress. However, the potential relationship between headache and tinnitus remains unclear. This study will investigate whether aberrant CBF patterns exist in chronic tinnitus patients and examine the influence of headache on CBF alterations in chronic tinnitus. Methods: Participants included chronic tinnitus patients (n=45) and non-tinnitus controls (n=50), matched for age, sex, education, and hearing thresholds. CBF images were collected and analyzed using arterial spin labeling (ASL) perfusion functional magnetic resonance imaging (fMRI). Regions with major CBF differences between tinnitus patients and non-tinnitus controls were first detected. The interaction effects between headache and tinnitus for CBF alterations were further examined. Correlation analyses illustrated the association between CBF values and tinnitus severity as well as between CBF and degree of headache.Results: Compared with non-tinnitus controls, chronic tinnitus patients exhibited decreased CBF, primarily in right superior temporal gyrus (STG), bilateral middle frontal gyrus (MFG), and left superior frontal gyrus (SFG); decreased CBF in these regions was correlated with tinnitus distress. There was a significant interaction effect between headache and tinnitus for CBF in right STG and MFG. Moreover, the degree of headache correlated negatively with CBF in tinnitus patients.Conclusions: Chronic tinnitus patients exhibited reduced CBF in the auditory and prefrontal cortex. Headache may facilitate a CBF decrease in the setting of tinnitus, which may underlie the neuropathological mechanisms of chronic tinnitus comorbid with headache.

Self-motion perception is sensitized in vestibular migraine: pathophysiologic and clinical implications

Vestibular migraine (VM) is the most common cause of spontaneous vertigo but remains poorly understood. We investigated the hypothesis that central vestibular pathways are sensitized in VM by measuring self-motion perceptual thresholds in patients and control subjects and by characterizing the vestibulo-ocular reflex (VOR) and vestibular and headache symptom severity. VM patients were abnormally sensitive to roll tilt, which co-modulates semicircular canal and otolith organ activity, but not to motions that activate the canals or otolith organs in isolation, implying sensitization of canal-otolith integration. When tilt thresholds were considered together with vestibular symptom severity or VOR dynamics, VM patients segregated into two clusters. Thresholds in one cluster correlated positively with symptoms and with the VOR time constant; thresholds in the second cluster were uniformly low and independent of symptoms and the time constant. The VM threshold abnormality showed a frequency-dependence that paralleled the brain stem velocity storage mechanism. These results support a pathogenic model where vestibular symptoms emanate from the vestibular nuclei, which are sensitized by migraine-related brainstem regions and simultaneously suppressed by inhibitory feedback from the cerebellar nodulus and uvula, the site of canal-otolith integration. This conceptual framework elucidates VM pathophysiology and could potentially facilitate its diagnosis and treatment.