Annals Of Headache Medicine Journal最新文献

{"title":"Autonomic Dysfunction among Migraineurs with and without Complaints of Orthostatic Intolerance: Evidence for Small Fiber Nerve Damage","authors":"M. Stillman","doi":"10.30756/ahmj.2021.06.01","DOIUrl":"https://doi.org/10.30756/ahmj.2021.06.01","url":null,"abstract":"Background and Objective: Migraineurs often complain of orthostatic intolerance (OI), and its recognition is vital to appropriate treatment. This study attempts to identify and characterize autonomic dysfunction, comparing a sample of migraineurs with OI with a sample of migraineurs without OI.\u0000\u0000Methods: In a prospective cohort study, we examined one migraine sample complaining of OI for > 6 months (Group 1) and another group without OI (Group 2), using a 70-degree, 45-minute head-up passive tilt-table (HUT45) test, electrocardiographic R-R interval measurements during deep breathing, blood pressure and heart rate monitoring during Valsalva and release, QSART, and skin biopsy for nerve fiber density. We compared results with standard, 10-minute head-up passive tilt-table (HUT10) results to determine which test promoted greater sensitivity, specificity and diagnostic accuracy.\u0000Descriptive statistics were computed for each group, defined by the presence or absence of OI. We conducted several receiver operating characteristic analyses to determine whether certain clinical characteristics were predictive of symptoms of OI.\u0000 \u0000Results: Thirty-nine Group 1 and 22 Group 2 subjects were studied and were similar demographically. Thirty eight of 39 (97.4%) Group 1, versus 15/22 (68.2%) Group 2 subjects, manifested abnormal HUT45 results, a significant difference (p=0.002). The HUT45 showed higher sensitivity (0.59; 95% CI: 0.42-0.74) than the standard 10-minute tilt-table test (HUT10) for all expressions of OI (0.31; 95% CI: 0.17-0.48). No differences in autonomic laboratory or skin biopsy findings distinguished the groups. We detected biopsy-proven small fiber neuropathy in 22/39 (56.4%) Group 1 and 10/22 (45.5%) Group 2 subjects.\u0000\u0000Discussion and Conclusions: In migraineurs, OI is an expression of autonomic dysfunction. We found evidence for a peripheral autonomic deficit on skin biopsy in 45% or more of both groups of migraineurs. Extending the head-up tilt table test to 45-minutes increases diagnostic sensitivity, spares patients misdiagnosis and unnecessary testing, and satisfies the principle of ecological validity.","PeriodicalId":131981,"journal":{"name":"Annals Of Headache Medicine Journal","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126684616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Treatment and Associated Healthcare Resource Use Among Migraine Patients in Germany","authors":"Fraence Hardtstock","doi":"10.21203/rs.3.rs-57269/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-57269/v1","url":null,"abstract":"Background: In order to evaluate unmet therapeutic need, this study sought to describe treatment patterns, as well as associated healthcare resource use (HCRU) and costs incurred by migraine patients in Germany.\u0000\u0000Methods: We conducted a retrospective analysis of a German claims dataset from 2013-2017, including over three million publicly-insured patients. Adult patients were included if they received at least one inpatient and/or two confirmed outpatient claims for headache/migraine from 2013-2016. Using prescription data from 2017, patients were separated into four main cohorts: those receiving prescriptions for (1) acute agents only, (2) prophylactic agents only, (3) both acute and prophylactic agents, and (4) neither acute nor prophylactic agents. Baseline characteristics were observed from 2013-2016; treatment and HCRU/cost outcomes were assessed in 2017.\u0000\u0000Results: In total, 199,283 patients were included in this analysis (mean age, 49.49 years; 73.04%, female) and 9,005 prophylactic therapy starters were identified. Overall, 43.47% of migraine patients did not receive acute or prophylactic medication in 2017, while 33.81% received only acute treatment, 9.45% received only prophylactic medication and 13.28% received both. Only 28.90% of patients initiating a prophylactic treatment were persistent after two years. HCRU was elevated for all groups, while direct costs ranged from €2,288-7,246 per year, and indirect costs ranged from €868-1,859.\u0000\u0000Conclusions: Despite high levels of HCRU, few migraine patients were treated with prophylactic agents, and those who did were at an elevated risk of early discontinuation. Ultimately, these findings indicate a resounding need for safe, timely, and efficacious use of prophylaxis among migraine patients.","PeriodicalId":131981,"journal":{"name":"Annals Of Headache Medicine Journal","volume":"90 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132737201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Critical Look at the Data Supporting Ultrasound Guided Cervical Medial Branch Blocks","authors":"M. Barad","doi":"10.30756/ahmj.2020.03.02","DOIUrl":"https://doi.org/10.30756/ahmj.2020.03.02","url":null,"abstract":"According to guidelines published by the American Society of Interventional Pain Physicians in 2013 ‎1, ‎2, the current evidence for cervical facet joint injections is fair. Yet the volume of these procedures continues to rise ‎3. There is a need for a more critical appraisal of the benefit, technique and adverse effects associated with cervical spine injections. The systematic review and meta-analysis by Paredes et al ‎4 seeks to better assess the evidence for use of ultrasound (US) guidance with cervical medial branch blocks. This article is also a response to a recently published critique by Schneider et al ‎5 raising concerns about the paucity of evidence evaluating the safety, accuracy, and effectiveness of US-guided cervical spine procedures.","PeriodicalId":131981,"journal":{"name":"Annals Of Headache Medicine Journal","volume":"208 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115903525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin as a Potential Treatment in Selected Migraine Sufferers: Two Case Reports","authors":"D. Levenson","doi":"10.30756/ahmj.2020.02.08","DOIUrl":"https://doi.org/10.30756/ahmj.2020.02.08","url":null,"abstract":"Objectives\u0000To review the change in headache frequency of two diabetic patients before and after initiation of insulin therapy, and to generate hypotheses regarding possible mechanisms underlying the potential link between headaches and glucose regulation.\u0000\u0000Case Report\u0000Hyperglycemia and hypoglycemia are both triggers for migraines. We present a series of two cases of women with diabetes who were started on insulin therapy in an attempt to reduce the frequency of their chronic migraine headaches. To our knowledge, this is the first such report in the literature. Both patients had glucose control at goal (A1c <6.5) and otherwise would not have warranted initiation of insulin. One patient had a 90% reduction in migraine frequency. The other had a 50% reduction in migraine frequency, and an 80-90% reduction in cluster headache frequency. \u0000\u0000Conclusion \u0000Fluctuations in glucose levels, rather than changes in insulin levels, are the likely triggers of the headaches seemingly associated with carbohydrate consumption. Judicious use of insulin in carefully selected patients may represent a novel method of preventing migraines.","PeriodicalId":131981,"journal":{"name":"Annals Of Headache Medicine Journal","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129771930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Pain Medicine Fellowships Provide Adequate Education in Head and Facial Pain? A Survey of Pain Medicine Fellowship Program Directors","authors":"L. Kohan","doi":"10.30756/ahmj.2020.02.05","DOIUrl":"https://doi.org/10.30756/ahmj.2020.02.05","url":null,"abstract":"Background: Fellows with insufficient education in head and facial pain may feel ill equipped to treat patients suffering from these disabling disorders. We hypothesized that there is variation in the scope and extent of headache and facial pain education that pain fellows receive during their pain fellowship.\u0000\u0000Study Design: A survey\u0000\u0000Setting: Accreditation Council for Graduate Medical Education (ACGME) Accredited pain medicine fellowship programs.\u0000\u0000Methods: After an exemption was obtained from the University of Virginia Institutional Review Board (IRB), an email with a link to the survey was sent to members of the Association of Pain Program Directors (APPD). The survey was also distributed to Association of Pain Program Director members at the annual 2019 APPD meetings during the Annual Society of Associations of Academic Anesthesiologists and Perioperative Medicine (SAAAPM) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) meetings. The survey contained 16 questions. (questions are shown in Appendix 1).\u0000\u0000Results: Forty-seven of 108 program directors responded to the survey. Some program directors did not respond to every question.\u0000\u0000Limitations: The response rate is a limitation, but it is comparable to similar studies.\u0000\u0000Conclusions: The majority of pain fellows receive some education in head and facial pain. However; there were variations among fellowship programs in the extent and scope of education provided. Recognizing these gaps and variations in education, may lead to a better understanding of how to enhance and provide head and facial pain education during pain fellowship.","PeriodicalId":131981,"journal":{"name":"Annals Of Headache Medicine Journal","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129040257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Primary Headache in the Emergency Department","authors":"Richard M. Pescatore","doi":"10.30756/10.30756/ahmj.2020.02.01","DOIUrl":"https://doi.org/10.30756/10.30756/ahmj.2020.02.01","url":null,"abstract":"Headache is a common presentation to emergency departments (EDs), comprising nearly 4% of all ED admissions.‎1 While the overwhelming majority of patients present with a primary headache disorder, particularly migraine, the emergency physician’s role calls for the simultaneous exclusion of severe or life-threatening pathology while providing judicious and effective symptom relief.‎2 Notably, recent investigations suggest that this dual mandate performs well, excluding more than 99% of conditions resulting in serious adverse neurologic sequelae, though at the cost of high-frequency and low-yield advanced imaging utilization.‎3‎, 4 While a comprehensive understanding of the diagnostic process and underlying pathophysiology associated with headache disorders is critical for the emergency clinician, this review is meant to chiefly describe the treatment of primary headache and the variety, efficacy, and indications of those interventions. While individual headache type classification can be helpful in targeting approach or therapy, diagnosis can be difficult in the emergency setting, and primary headaches of most types are often approached similarly in the ED. Interestingly, the overwhelming majority of patients who present to an emergency department with acute primary headache have migraine, but the majority of patients receive a less specific diagnosis and a treatment that is correspondingly nonspecific.‎5 Importantly, however, the dynamic, diverse, and unique nature of different headache presentations to the ED make an algorithmic or step-wise approach to headache management ill-advised. The emergency practitioner must have a working knowledge of the array of treatment options available and apply therapies in a considered and informed manner. Following effective analgesia, however, the most important intervention emergency physicians can deliver for their headache patients is to connect them with outpatient physicians savvy about headache management, who will then provide these headache patients with appropriate acute therapeutics, initiate preventive therapy and provide anticipatory guidance about their disease process.‎6","PeriodicalId":131981,"journal":{"name":"Annals Of Headache Medicine Journal","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115364487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}