Necdet Karli

Comparison of Pre-Headache Phases and Trigger Factors of Migraine and Episodic Tension-Type Headache: Do they Share Similar Clinical Pathophysiology?

Trigger factors, signs and symptoms of the preheadache phases of episodic tension-type headache (ETTH), typical aura with non-migraine headache (TANMH), migraine with (MA) and without aura (MwA) may show similar features. Our objective was to investigate the preheadache phases and trigger factors of these headache types. Questionnaires including trigger factors, signs and symptoms of preheadache phases were answered by all headache patients. A total of 96 patients, 31 ETTH, nine TANMH, 23 MA and 33 MwA patients were included in this study. Analysis of seven groups consisting of 18 individual trigger factors showed that only two groups and five individual trigger factors were significantly different between groups. Hunger and odour were significantly more common in MA, MwA and TANMH patients. Foods were a significant precipitant factor for headache in MA patients. Head and neck movements were important trigger factors in ETTH. In prodrome phase only one out of three groups differed significantly between headache types. Migraine and TANMH patients reported significantly more general signs and symptoms. Analysis of aura signs and symptoms showed that only two out of six groups were significantly more frequent in MA and TANMH patients. Visual aura symptoms were more frequent in MA and TANMH groups, where sensorial auras were reported to be the most frequent in the MA group. Our results showed that different type of headaches share common prodrome and aura signs and symptoms as well as the same trigger factors. We suggest that similar trigger factors may trigger similar mechanisms and may cause common preheadache signs and symptoms in all headache types.

Headache prevalence in adolescents aged 12 to 17: a student-based epidemiological study in Bursa.

Background and Objectives.—The objective of this study was to investigate the prevalence and sociodemographic characteristics of headaches among Turkish adolescents aged 12 to 17 years old in Bursa province of Turkey.

Clinical characteristics of tension-type headache and migraine in adolescents : A student-based study

Background and objectives.—Adolescent headaches, particularly migraine, might present with different features from adult headaches. The objectives of this study were to investigate the characteristics of tension‐type headache and migraine, to find the sensitivity and specificity of the diagnostic criteria of the IHS classification according to age and gender.

Can ID MigraineTM be Used as a Screening Test for Adolescent Migraine

Although the ID MigraineTM has been developed and used for adults, it can also be used in adolescents. We aimed to investigate the validity of the ID MigraineTM in the adolescent student population. The study was performed on 1064 adolescents aged 12-17 years. A face-to-face semistructured interview was conducted with students after they had answered a 17-item questionnaire on sociodemographics and headache. Students who had had two or more headache attacks during the last 3 months then answered the ID MigraineTM. The sensitivity and specificity of the ID MigraineTM were 62.1± and 71.1±, respectively. The sensitivity was higher for patients with migraine with aura (71.1±), for girls (71.3±) and for younger adolescents (69.1±). The specificity was higher for boys (77.9±) and for older adolescents (73.3±). The K value was 0.316 (P< 0.001). Although the K value of the ID MigraineTM is low, the test may be a useful tool in screening adolescent migraine after some changes are made.

Citicoline improves functional recovery, promotes nerve regeneration, and reduces postoperative scarring after peripheral nerve surgery in rats

BACKGROUND Citicoline has been shown to have beneficial effects in a variety of CNS injury models. The aim of this study was to test the effects of citicoline on nerve regeneration and scarring in a rat model of peripheral nerve surgery. METHODS Seventy adult Sprague-Dawley rats underwent a surgical procedure involving right sciatic nerve section and epineural suturing. Rats were assigned to the control or experiment groups to receive a topical application of 0.4 mL of saline or 0.4 mL (100 micromol/L) of citicoline, respectively. Macroscopic, histological, functional, and electromyographic assessments of nerves were performed 4 to 12 weeks after surgery. RESULTS In the control versus citicoline-treated rats, SFI was -90 +/- 1 versus -84 +/- 1 (P < .001), -76 +/- 4 versus -61 +/- 3 (P < .001), and -66 +/- 2 versus -46 +/- 3 (P < .001) at 4, 8, and 12 weeks after surgery, respectively. At 12 weeks after surgery, axon count and diameter were 16400 +/- 600 number/mm(2) and 5.47 +/- 0.25 microm versus 22250 +/- 660 number/mm(2) (P < .001) and 6.65 +/- 0.28 microm (P < .01) in the control and citicoline-treated groups, respectively. In citicoline-treated rats, histomorphological axonal organization score at the repair site was (3.4 +/- 0.1) significantly better than that in controls (2.6 +/- 0.3) (P < .001). Peripheral nerve regeneration evaluated by EMG at 12 weeks after surgery showed significantly better results in the citicoline group (P < .05). Nerves treated with citicoline demonstrated reduced scarring at the repair site (P < .001). CONCLUSION Our results demonstrate that citicoline promotes regeneration of peripheral nerves subjected to immediate section suturing type surgery and reduces postoperative scarring.

Intramuscular tramadol vs. diclofenac sodium for the treatment of acute migraine attacks in emergency department: a prospective, randomised, double–blind study

The aim of this prospective, randomised, double–blind study was to evaluate the efficacy of intramuscular (IM) tramadol 100 mg in emergency department treatment of acute migraine attack and to compare it with that of IM diclofenac sodium 75 mg. Forty patients who were admitted to our emergency department with acute migraine attack according to the International Headache Society criteria were included in the study. Patients were randomised to receive either tramadol 100 mg (n=20) or diclofenac sodium 75 mg (n=20) intramuscularly. Patients rated their pain on a four–point verbal scale (0=none, 1=mild, 2=moderate, 3=severe) at the beginning of the trial and at 30, 60, 90 and 120 min. At each time interval, severity of associated symptoms were also questioned and recorded. Global evaluation of the drugs by patients and doctors were also recorded. Patients were also asked if they would prefer the same injection in future visits. Any adverse events, whether related to the drug or not, were also recorded. Patients were followed up by telephone 48 h later to check for any headache recurrence. Two–hour pain response rate, which was the primary endpoint, was 80% for both tramadol and diclofenac groups. There were no statistically significant differences among groups in terms of 48–h pain response, rescue treatment, associated symptoms’ response, headache recurrence and adverse event rates. Fifteen (75%) patients in the tramadol group and 16 (80%) patients in the diclofenac group stated that they may prefer the same agent for future admissions. In selected patients, tramadol 100 mg IM may be an effective and reliable alternative treatment choice in acute migraine attacks.

The prevalence and clinical features of restless legs syndrome: a door to door population study in Orhangazi, Bursa in Turkey.

BACKGROUND Restless leg syndrome (RLS) has negative effects on the quality of life of the patients. Epidemiological studies on RLS are limited. AIM To determine the prevalence of RLS among people aged 40 years and above in Orhangazi district of Bursa, Turkey. MATERIALS AND METHODS The study was carried out between 2004 and 2005. This population-based study was conducted in two phases. In the phase 1, residents conducted door-to-door interviews using a short questionnaire to determine the possible cases of RLS. In the phase 2, physicians ascertained the suspected cases of RLS. Diagnosis of RLS was made using the criteria proposed by the International Restless Legs Syndrome Study Group (IRLSSG) and also the rating scale for RLS. RESULTS Out of 1, 256 subjects screened in phase 1, 1,124 (89.6%) were included in the study. Also, 161 cases with suspected symptoms of RLS were detected in phase 1, 49 of the suspected cases could not be evaluated in phase 2. A diagnosis of RLS was also made in 60 cases during phase 2. CONCLUSIONS We defined the prevalence of RLS as 9.71% among 40 years of age and older population. The prevalence of RLS did not differ by age and was 2.6 times more in women. None of the patients were diagnosed as RLS sought medical care for the symptoms, possibly due to lack of knowledge of patients and physicians about RLS. Prevalence studies help to provide knowledge on morbidity, which is essential for diagnosis and early treatment.

The validation of ID migraine™ screener in neurology outpatient clinics in Turkey

The aim of this study was to investigate the validity of the ID Migraine™ test in neurology outpatient clinics (NOCs), regardless of their presenting complaints. Patients admitted to 41 NOCs were screened. Eligible subjects (n=3682) were evaluated by a neurologist for headache diagnosis according to the International Headache Society criteria and asked the 3-item screening questions of the ID Migraine™ test. Of 3682 patients, 917 (24.9%) were diagnosed as migraine, whereas 1171 (31.8%) were ID Migraine™ test positive. The sensitivity of the ID Migraine™ test for neurologist’s diagnosis of migraine was 91.8%, specificity was 63.4%, positive predictive value was 71.9% and negative predictive value was 88.4%. The ID Migraine™ test is easy to use and a practical test that could alert the neurologist to diagnose patients having other complaints. This test would help to increase the diagnosis and treatment rate of undiagnosed migraine patients in NOCs.

Characterization of Migraineurs Having Allodynia: Results of a Large Population-based Study.

Objective:Allodynia reflects the clinical correlate of central sensitization, but it is usually neglected in clinical headache management. We aimed to report the prevalence and previously unnoticed associations of allodynia in migraineurs by a nationwide face-to-face questionnaire-based study by physicians. Methods:A total of 5323 households were examined for headache according to the diagnostic criteria of International Classification of Headache Disorders-II. Detailed headache features, premonitory signs, demographics, socio-economic status, and hormonal status of female individuals were analyzed with regard to the presence of allodynia in patients with definite migraine. Results:Allodynia was present in 61.1% of migraineurs in the general population of Turkey. The duration and severity of attacks (P<0.0001), photophobia (P=0.001), phonophobia, and also osmophobia (P<0.0001), as well as premonitory signs (P=0.018), showed significant associations with allodynia. Migraineurs with aura or family history of migraine more often reported allodynia in comparison with those without (P=0.001 and 0.028, respectively). Allodynic migraineurs had a higher rate of physician consults and high levels on the Migraine Disability Assessment questionnaire, reflecting increased burden of headache. Furthermore, migraineurs with allodynia had high probability of attacks close to menses. Migraine improved during pregnancy, but it worsened after menopause or during oral contraceptive use in individuals experiencing allodynia when compared with those without allodynia. Discussion:The duration, severity, and disability of migraine attacks, photophobia, phonophobia, and osmophobia, as well as premonitory signs, showed significant associations with allodynia in the general population. Moreover, migraineurs with aura or family history of migraine more often reported allodynia, and allodynic migraneurs were more sensitive to hormonal changes. Allodynia, which seems to indicate higher tendency to central sensitization, should be implemented in daily headache practice to predict the prognosis and high levels of migraineous involvement.

The impact of education on the diagnostic accuracy of tension-type headache and migraine: a prospective study.

General practitioners (GPs) diagnose and treat headache in primary care settings. The objective of this study was to investigate the effect of a 2-day headache education programme for GPs primarily on diagnostic accuracy. The education programme included theoretical lectures and face-to-face patient evaluation with headache specialists. Three GPs evaluated headache patients before and after the programme. Each GP was planned to interview a total of 60 patients (30 before, 30 after the programme). All patients were evaluated by headache specialists following evaluation by the GPs. A total of 189 patients were included in this study. Diagnostic accuracy increased from 56.3% to 81.0% after the headache education programme (P < 0.001), which also significantly improved the choice of proper treatment (P = 0.043). The headache education programme for GPs significantly improved diagnostic accuracy in patients with tension-type headache and the choice of proper treatment. Such education programmes can be standardized and given to GPs working in the primary care setting. These programmes can be arranged locally by the universities and might have a favourable impact on the diagnosis and treatment of headache.