1,720,983 research outputs found
La cefalea da digiuno: Una revisione della letteratura e nuove ipotesi
No full textHeadache is a common disorder in the general population. It is often highly debilitating for the people affected and highly costly to society. Although we know much about primary headaches, little is known yet about secondary headaches, which, however, are a frequent occurrence in the general population. A study conducted on the Danish general population found a lifetime prevalence rate of 22% for headache forms attributed to homeostasis disorders, including fasting headache. The purpose of this review was to analyse literature data on fasting headache, in order to evaluate its possible pathogenetic mechanisms and to suggest therapeutic strategies. We considered only articles in English published in scientific journals. We searched for these articles on Pubmed using "headache", "fasting", "Yom Kippur", "Ramadan", "hypoglycemia", and "caffeine deprivation" as key words, with no limitations for the year of publication. In most cases, fasting headache had the same clinical features as tension-type headache and the probability of onset increased directly with the length of fasting. Hypoglycemia and caffeine deprivation have been especially implicated as causative factors. However, much remains to be understood on this subject
Efficacy and safety of greater occipital nerve block for the treatment of cluster headache: a systematic review and meta-analysis
No full text. The treatment of cluster headache (CH) is challenging in view of the few evidence-based treatments. The authors aim to summarize the evidence of efficacy and safety of greater occipital nerve blocks (GONBs) in CH
Two-year effectiveness of erenumab in resistant chronic migraine: a prospective real-world analysis
Full text linkBACKGROUND: Controlled and real-world evidence have demonstrated the efficacy of calcitonin gene related peptide (CGRP) monoclonal antibodies (MABs) in migraine. However, data on the over-one-year sustained effectiveness of CGRP MABs in resistant chronic migraine (CM) is sparse. METHODS: This is a two-year real-world prospective analysis of an ongoing single centre audit conducted in patients with resistant CM. Patients received monthly erenumab for six months before assessing its effectiveness. Responders were considered those who achieved at least 30% reduction in monthly migraine days (MMD) by month 6, compared to baseline. Secondary outcomes were also analysed, including changes of the Headache Impact Test version 6 (HIT-6). RESULTS: One hundred sixty-four patients [135 (82.3%) females; mean age 46 SD 14) years] were included in the audit and 160 patients analysed. Patients had failed a mean of 8.4 preventive treatments at baseline. At month 6, 76 patients (48%) were 30% responders to erenumab, 50 patients (31%) were 50% responders and 25 (15%) were 75% responders. The mean reduction in MMD at month 6 was 7.5 days compared to baseline (P < 0.001). At month 12 and month 18, 61 patients (38%) and 52 patients (33%) remained 30% responders respectively. At month 24, 36 patients (23%) remained 30% responders, 25 patients (16%) and 13 patients (8%) were respectively 50% and 75% responders. Compared to 95% of patients at baseline, at months 6, 12 and 24, 46%, 29% and 16% of responders respectively had severe disability. At least one adverse event at month 6, 12, 18 and 24 was reported by 49%, 19%, 11% and 3% of patients. By month 6, 13% of patients discontinued the treatment because of side effects, often constipation. CONCLUSIONS: Long-term sustained effectiveness of erenumab was reported only by a minority of resistant CM patients. Although more research in resistant migraine is needed, Erenumab can provide long-term meaningful reduction in migraine load and migraine-related disability in some patients
Sphenopalatine Ganglion Pulsed Radiofrequency for the Treatment of Refractory Chronic SUNCT and SUNA: A Prospective Case Series
No full textWe aimed to evaluate the safety and effectiveness of sphenopalatine ganglion pulsed radiofrequency (SPG-PRF) for the treatment of patients with refractory chronic short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and with cranial autonomic symptoms (SUNA)
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
The Clinical, Therapeutic and Radiological Spectrum of SUNCT, SUNA and Trigeminal Neuralgia
Full text linkThis thesis examines and compares the demographics, clinical phenotype, radiological findings and response to medical and surgical treatments of SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) and SUNA (short-lasting unilateral neuralgiform headache attacks with autonomic symptoms). Given the similarities between SUNCT, SUNA and trigeminal neuralgia (TN), the demographics and clinical phenotype of these disorders were also compared. In the first study (Chapter 2) a cohort of 133 patients (SUNA=63 and SUNCT=70) was phenotyped and the clinical characteristics of SUNA compared to those of SUNCT. Statistically significant predictors for SUNCT rather than SUNA were only found for ipsilateral ptosis [OR: 3.37 (95% CI: 1.50, 7.66), p<0.0001] and rhinorrhoea [OR: 2.42 (95% CI: 1.09, 5.41), p=0.034]. Furthermore, a significantly higher proportion of SUNCT patients (n=56, 80.0%) reported marked lacrimation compared to SUNA patients (n=20, 46.5%) (P<0.001). In the second study (Chapter 3) 45 SUNCT and 34 SUNA patients had high-resolution cisternal imaging MRI scans to asses the presence of trigeminal neurovascular conflict. The prevalence of neurovascular contact on the symptomatic trigeminal nerves was higher (57.3%) than on the asymptomatic trigeminal nerves (25%) (P≤0.001). Severe neurovascular contacts were considerably more prevalent on the symptomatic side (47.6%), compared to the asymptomatic side (11.8%) (P≤0.001). There was no statistically significant difference in the proportion of neurovascular contacts on the symptomatic nerves between SUNCT (61.7%) and SUNA (57.1%) (P=0.67). The presence of a vascular contact and its location at the root entry zone were strong predictors for the nerve to be symptomatic rather than asymptomatic. In the third study (Chapter 4) the response to treatments of 161 SUNCT and SUNA patients was analysed. Our findings suggest that lamotrigine was the most effective treatment (responders: SUNCT= 53.5%, SUNA= 57.9%) followed by oxcarbazepine (responders: SUNCT= 44.8%, SUNA= 47.0%); duloxetine and topiramate were more effective in SUNCT rather than SUNA (duloxetine responders: SUNCT= 45.0%, SUNA: 11.8%; p= 0.027; topiramate responders: SUNCT= 33.3%, SUNA= 10.7%; p=0.028). Amongst transitional treatments intravenous lidocaine led to a significant headache improvement in 83.3% SUNCT (n=25) and in 76.5% SUNA (n=13) patients (p=0.73). A greater occipital nerve block was beneficial in 27.3% (n=21) of patients for a median of 21 days (IQR: 53 days; range: 1 to 150 days), without any significant difference between SUNCT (24.4%; n=11) and SUNA (37.0%; n=10) patients (p=0.42). We found intravenous dihidroergotamine able to worsen or even to precipitate a de novo SUNCT/SUNA when administered to manage a different primary headache disorder. In the fourth study (Chapter 5) occipital nerve stimulation (ONS) was tried in nine and trigeminal microvascular decompression was tried in ten refractory, chronic SUNCT and SUNA patients. At a median follow-up of 38 months (range 24-55 months) ONS led to a marked headache improvement in eight of the nine patients (89%). One patient did not report any benefit from the stimulator at 24 months’ follow-up and opted to have the ONS explanted. At a mean follow-up fo 19.6 months (range: 12-36 months) after trigeminal microvascular decompression surgery, seven patients (70%) became headache-free after the operation. Five of the seven patients (71.4%) remained headache-free at the last follow-up. The remaining two patients were headache-free respectively for 9 and 12 months before the headache relapsed. There were no major surgical and post-surgical complications. A comparison of the clinical phenotype of SUNA (n=133) and TN (n=79) was undertaken in the last study (Chapter 6). Several similarities between SUNA and TN were found. Furthermore, some clinical features, namely pain location in V1 (OR: 11.29 95%CI: 3.92, 35.50, p<0.001), spontaneous only attacks (OR: 44.40, 95%CI: 4.50, 437.83, p=0.001) and a chronic pain pattern (OR: 13.19, 95%CI: 4.04, 43.08, p<0.001) predicted the diagnosis of SUNA rather than TN. Similarly duration of the attacks <1 minute (OR: 7.95, 95%CI: 2.30, 27.57, p=0.001) and the presence of a refractory period in between triggered attacks (OR: 0.06; 95%CI: 0.02, 0.28, p-value <0.001) were predictors for TN rather than SUNA. In summary our novel findings advance the clinical understanding of SUNCT and SUNA and suggest that their relationship with TN may represent` a clinical continuum between disorders. This view will hopefully open novel research directions towards a better understanding of these complex clinical entities
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