Levent Ertugrul Inan

Background: Idiopathic intracranial hypertension without papilledema (IIHWOP) is increasingly recognized, but its clinical characteristics and treatment-related outcomes remain insufficiently defined. This study aimed to compare patients with idiopathic intracranial hypertension (IIH) with and without papilledema. Methods: This retrospective observational cohort study included adult patients diagnosed with IIH at a tertiary neurology and referral center. Demographic, clinical, neuro-ophthalmologic, radiological, lumbar puncture, and treatment-related characteristics were compared according to papilledema status. Results: Among 123 patients with IIH, 83 (67.5%) had papilledema, and 40 (32.5%) had IIHWOP. Age, sex distribution, body mass index, lumbar puncture opening pressure, and most neuroimaging findings were similar between groups. In exploratory between-group analyses, photophobia [35/40 (87.5%) vs. 55/83 (66.3%), p = 0.023], phonophobia [35/40 (87.5%) vs. 56/83 (67.5%), p = 0.031], and nausea/vomiting [20/40 (50.0%) vs. 17/83 (20.5%), p = 0.002] were more frequent among patients with IIHWOP than among those with papilledema. Diabetes mellitus was also more frequent in the IIHWOP group [8/40 (20.0%) vs. 5/83 (6.0%), p = 0.040]. Treatment persistence did not differ significantly between groups (log-rank p = 0.604). In multivariable analysis, papilledema was associated with higher odds of failure to achieve a complete treatment response, whereas higher lumbar puncture opening pressure was associated with lower odds of treatment nonresponse. Conclusions: Exploratory analyses suggested that patients with IIHWOP may exhibit a different clinical presentation characterized by more prominent migraine-like symptoms. However, these exploratory observations require confirmation in prospective studies.

Medication overuse headache (MOH) is a chronic headache (CH) that develops or worsens due to medication overuse. Somatization and hypochondriasis, as well as beliefs about the experienced pain, may accompany many chronic pain situations from a holistic perspective. This study aimed to compare MOH patients with CH and episodic headache (EH) in terms of somatization, hypochondriasis, and beliefs and attitudes on pain. The Hospital Depression and Anxiety Scale (HADS), the Somatosensory Amplification Scale (SSAS), the Pain Beliefs Questionnaire (PBQ), the Pain Catastrophizing Scale (PCS), Eysenck Personality Questionnaire Revised–Short Form (EPQR-S), and Whiteley index-7 (WI-7) were administered to the participants with MOH (n = 80), CH (n = 81), and EH (n = 79). There were no group differences in terms of somatic amplification between MOH and CH group. A high WI_Total score (lower hypochondriacal tendency) was predictive in separating the MOH group from the CH one. The score obtained from the PBQ_Organic subscale in the MOH group was significantly lower than the EH group, while the PCS_Total, PCS_Helplessness, PCS_Rumination, and HADS scores were significantly higher (p < 0.05). Our results indicate that the patients in the MOH group had more organic pain beliefs, felt more helpless in case of pain, and experienced exaggeration and rumination more than the EH group, while hypochondriasis was lower than in the CH group. This could indicate that patients with MOH do not seek further treatment that can lead to more headache medication use without medical examination.

Morgagni-Stewart-Morel (MSM) syndrome is characterized by the thickening of the frontal bone of the skull (hyperostosis frontalis interna) obesity, neurological symptoms, and hypertrichosis. We present the case of a 76-year-old patient who complained of confusion, extreme irritability, and headache and was diagnosed with MSM based on examination, imaging, and test results.

Objective: Recent studies have shown that sleep problems occur in migraineurs and poor sleep causes chronification, but the mechanisms by which chronic migraine affects sleep quality are still unknown. This review aims to analyze commonly reported sleep disturbances in chronic migraine (CM) and determine the effect of CM on sleep quality. Materials and Methods: We conducted a comprehensive review of all published articles on CM and sleep quality from inception to March 2022 in the literature. Clinical trials, observational studies, and case series (≥ 20 cases) were included. Two reviewers and a supervisor reviewed the titles and abstracts of all search results with predefined inclusion and exclusion criteria. PubMed search for randomized controlled trials and open studies on CM and sleep quality reported in English between 1983 and 2022 was conducted using the keywords including chronic migraine, sleep, insomnia, sleep quality, polysomnography, and Pittsburgh Sleep Quality Index. Results: A total of 535 potentially relevant articles were found. A total of 455 articles and reviews, meta-analyses published in any language other than English, with other exclusion criteria, were excluded from the review. In the remaining articles, 36 clinical studies, reviewing sleep quality and its association with migraine, were identified and reviewed. Evidence from this review shows that poor sleep and migraine chronicity are intertwined with other accompanying comorbidities and dysregulation of circadian rhythm that innovative treatments promise to bring relief to both poor sleep as well as migraine. Conclusion: Sleep disorders are common in CM and the association between migraine chronification and sleep quality is bidirectional. Comorbid conditions with accompanying frequent attacks in migraine may impair sleep quality. While the maladaptive pain process worsens sleep, poor sleep quality also negatively affects migraine pain. Sleep disturbance, which is affected by worsening migraine attacks, causes deterioration in the quality of life, loss of workforce, and economic burden.

Başağrısı, basit bir ağrı değil, değerlendirme aşamasında bilgi ve donanım birikimi, ayrıca hekimlik sanatı gerektiren bir temel semptomdur. Türk Nöroloji Derneği çatısında faliyetlerine başlayan Başağrısı Çalışma Grubu, aynı çalışma grubunun yurt içi ve yurt dışı eğitim faaliyetlerini sürdürme amacıyla oluşturduğu Başağrısı ve Ağrı Çalışmaları Derneği başağrısı tanı ve tedavisinin yanı sıra eğitim ve araştırmalarının da bu işin uzmanları tarafından yapılması gerektiğine inanmaktadır. Bu amaçla bu iki yapı uzun yıllardırortak platformda eğitimi destekleyen çalışmalarına devam etmektedir. Bu amaç dahilinde, Türkiye ‘nin pek çok bölgesinde gönüllülük esası ile, uzman ve aile hekimlerine başağrısı eğitimi verilmiş, halkı bilgilendirme toplantıları düzenlenmiştir. Artan üye sayımız ve tüm üyelerimizin ülke çapında ve uluslararası gerek eğitim, gerekse bilimsel platformlarda gösterdiği başarılar kalıcı bir eserin ortaya konulmasında bizleri yüreklendirmiştir. Bu kitabın hedef kitlesi nöroloji, algoloji asistan ve uzmanları başağrısı konusuna ilgi duyan aile hekimleri ve farklı ilgili branşlardaki meslektaşlarımız olarak belirlenmiştir. Tıp eğitimi standardizasyonu kapsamında, pratik uygulamalarda çok sık görülmesine karşın, başağrısı için yeterli süre ayrılamamaktadır. Pandemi süreci bu eğitime negatif etki etmiştir. Bu kitap meslektaşlarımızın başağrısında her başlıkta başvuracakları temel kaynak olması açısından büyük önem taşımaktadır.

Background: Few studies have explored the coexistence of migraine and disordered eating attitudes. Furthermore, the underlying pathophysiological mechanisms of migraine and disordered eating attitude comorbidity are not clearly understood. Objective: This study aimed to investigate the association between migraine and disordered eating attitudes in relation to personality traits, obesity, quality of life, migraine severity, depression, and anxiety. Methods: This study included 91 patients with episodic migraine and 84 healthy control subjects. Self-report questionnaires were used to evaluate anxiety, depression, migraine-related disability, personality traits, quality of life, and eating disorders. Results: The Eating Attitude Test (EAT) showed disordered eating attitudes in 21 patients (23.1%) in the migraine group and eight patients (9.5%) in the control group. Migraine-related disability, anxiety, depression, neuroticism, and quality of life scores were significantly worse in migraine patients with disordered eating attitudes compared to migraine patients without disordered eating attitudes. In migraine patients, eating attitude test scores were positively correlated with migraine-related disability, anxiety, depression, and neuroticism scores, and negatively correlated with quality of life scores. Conclusion: The association of migraine and disordered eating attitudes was shown to be related to depression, anxiety, quality of life and personality traits and may also indicate a more clinically severe migraine. To the best of our knowledge, there is no literature study that deals with all these relevant data together. However, neuropsychiatry-based biological studies are required to better understand this multifaceted association.