Mira Bučuk

Migraine and tension-type headache in Croatia : A population-based survey of precipitating factors

The careful monitoring of the trigger factors of headache could be an important step in treatment, because their avoidance may lessen the frequency and severity of attacks. Furthermore, they may provide a clue to the aetiology of headache. The aim of the present study was to estimate the prevalence of tension-type headache (TTH) and to establish the frequency of precipitating factors in subjects with migraine and TTH in the adult population of Bakar, County of the Coast and Gorski Kotar, Croatia. Another important purpose of the study was to examine the relationship of the precipitating factors with migraine and TTH, and with migraine subtypes: migraine with aura (MA) and migraine without aura (MO). We performed a population-based survey using a ‘face-to-face door-to-door’ interview method. The surveyed population consisted of 5173 residents aged between 15 and 65 years. The 3794 participants (73.3%) were screened for headache history according to the International Headache Society (IHS) criteria. Headache screen-positive responders, 2475 (65.2%), were interviewed by trained medical students with a structured detailed interview focused on the precipitating factors. The following precipitating factors in lifetime migraineurs and tension-type headachers have been assessed: stress, sleep disturbances, eating habits, menstrual cycle, oral contraceptives, food items, afferent stimulation, changes in weather conditions and temperature, frequent travelling and physical activity. A total of 720 lifetime migraineurs and 1319 tension-type headachers have been identified. The most common precipitants for both migraine and TTH were stress and frequent travelling. Stress (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.17, 1.69) was associated with migraine, whereas physical activity (OR 0.72, 95% CI 0.59, 0.87) was related to TTH. Considering MA and MO, frequent travelling (OR 2.2, 95% CI 1.59, 2.99), food items (OR 2.2, 95% CI 1.35, 3.51) and changes in weather conditions and temperature (OR 1.75, 95% CI 1.27, 2.41) exhibited a significant positive association with MA. The present study demonstrated that precipitant-dependent attacks are frequent among both migraineurs and tensiontype headachers. Lifetime migraineurs experienced headache attacks preceded by triggering factors more frequently than tension-type headachers. MA was more frequently associated with precipitating factors than MO. We suggest that some triggering factors may contribute to the higher occurrence of precipitant-dependent headache attacks in susceptible individuals.

Prevalence of migraine in Croatia: a population-based survey.

Objectives.—The aim of the present study was to estimate the prevalence of migraine among Croatian adults. This is the first epidemiological study of migraine in Croatia in which the operational diagnostic criteria of the International Headache Society have been applied.

Recurrent Transient Global Amnesia at High Altitude

We report the case of a 57-year-old man who experienced recurrent episodes of memory loss that resemble transient global amnesia (TGA). The first episode lasted 20 minutes, and the second was 8 hours long.

Epidemiology of primary central nervous system tumors in the Coast and Gorski Kotar County, Croatia, 1977-2000

Aim and Background To establish the incidence of primary tumors of the central nervous system (CNS) in the resident population of the Coast and Gorski Kotar County, Croatia, in the period 1977-2000. Methods A retrospective descriptive epidemiological study. Tumors were classified according to the World Health Organizations scheme. A total of 911 cases was identified. Information about patient gender and age at diagnosis, tumor location and histologic type was obtained from case histories, autopsy protocols and pathology reports. Age- and sex-adjusted incidence were determined by a direct standardization method. Results Histologic confirmation was obtained in 84.5% of cases. The most frequent tumors were glioblastoma in men (30.2%) and meningioma in women (29.5%). The average annual crude and world-standardized incidence was 11.2 (95% CI, 10.1-12.3) and 8.2/100,000/year (95% CI, 7.4-9.0), respectively. The highest specific age incidence was detected in the seventh decade of life, 24.7/100,000/year (95% CI, 21.4-28.8). The tumors occurred equally in each sex. The lowest incidence was detected on the islands, 7.4/100,000/year (95% CI, 5.9-9.2) and the highest along the coast, 12.7/100,000/year (95% CI, 11.4-14.0). The survey showed the highest incidence of these neoplasms in the coastal municipality of Senj, 14.7/100,000/year (95% CI, 10.3-20.5). Conclusion The descriptive epidemiological incidence of primary CNS tumors in the Coast and Gorski Kotar County, Croatia, especially those of neuroepithelial and meningeal origin, correspond to the data reported in similar studies elsewhere in the world. The incidence of these neoplasms in the area investigated is uneven. Limitations in study design preclude definitive conclusions about the causes of these differences.

A case with giant arachnoid cysts manifested as migraine.

A 69-year-old female with a diagnosis of essential hypertension presented with a sudden onset severe headache. For the last 15 years she had been suffering from headache that was diagnosed as migraine and treated accordingly. On admission except from headache described as pulsing, localized in occipital and temporal region, followed by nausea and vomiting, vital signs and neurological examination were normal. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain revealed giant arachnoid cysts in the temporal lobe and on the convexity of frontal lobe, 10x12x5.5 cm in dimension on the right side, and 8x7x5.5 cm on the left. Brain mass was hourglass-shaped. Temporal lobes were almost completely erased and parietal lobes reduced. Only occipital lobes were fully developed (Figs. 1, 2 and 3). Though surgery was advocated to her, she strongly refused it. At follow-up examination 3 years later she was doing fine and neurological examination showed no deficits. Arachnoid cysts are cavities with content similar to cerebrospinal fluid. They are often found incidentally, in 0.1% to 0.4% in the general population and they make up approximately 1% of all intracranial space-occupying lesions. Arachnoid cysts are the result of developmental abnormalities, but a small number of them are acquired, such as those in association with neoplasm or those that are due to adhesions following leptomeningitis, hemorrhage, or surgery. Neurological symptoms depend on location, although intracranial hypertension is the most frequent. They include headache, seizures, hearing and visual disturbances, vertigo, hemiparesis, ataxia and behavioral changes. Symptoms usually develop at an early age and are rarely seen in the elderly. Treatment is symptomatic. When symptoms warrant, the surgical placement of a shunt may be required to decompress the cyst. No general survey has yet been conducted regarding surgical treatment in elderly patients, since the result after surgery is rather unpredictable in these patients. Thus, minimally invasive fenestration techniques are available to offer low-risk surgical treatment in selected cases.