Objectives
Chronic migraine (CM) is a prevalent and devastating disorder with limited therapeutic options. This study explored the efficacy of 10 mg/d flunarizine for CM prophylaxis as compared with ...50 mg/d topiramate.
Methods
We conducted a prospective, randomized, open‐label, blinded‐endpoint trial. Patients with CM were randomized to flunarizine and topiramate treatment. The primary outcomes assessed were the reductions in the total numbers of headache days and migraine days after 8 weeks of treatment. Secondary outcomes were reductions in the numbers of days of acute abortive medication intake and acute abortive medication tablets taken, and the 50% responder rate.
Results
Sixty‐two subjects were randomized (n=31/group). Patients treated with flunarizine showed significant reductions in the numbers of total headache days (−4.9 vs −2.3, P=.012) and migraine days (−4.3 vs −1.4, P=.001) compared with those treated with topiramate. Patients treated with flunarizine also showed significant reductions in the numbers of days of acute abortive medication intake (−2.3 vs −0.2, P=.005) and acute abortive medication tablets taken (−4.6 vs −0.5, P=.005) and had a higher 50% responder rate in terms of total headache days (58.6% vs 25.9%, P=.013) and migraine days (75.9% vs 29.6%, P=.001), compared with topiramate‐treated patients. Flunarizine was generally well tolerated and had a safety profile comparable to that of topiramate.
Conclusions
Our results suggest that, in an 8‐week study, 10 mg/d flunarizine is more effective than 50 mg/d topiramate for CM prophylaxis.
To assess the diagnostic accuracy of heavily T2-weighted magnetic resonance myelography (MRM) in patients with spontaneous intracranial hypotension (SIH).
Patients with SIH were recruited ...prospectively, and first underwent MRM and then computed tomographic myelography (CTM). The results of MRM were validated with the gold standard, CTM, focusing on 1) CSF leaks along the nerve roots, 2) epidural CSF collections, and 3) high-cervical (C1-3) retrospinal CSF collections. Comparisons of these 3 findings between the 2 studies were made by kappa statistics and agreement rates. Targeted epidural blood patches (EBPs) were placed at the levels of CSF leaks if supportive treatment failed.
Nineteen patients (6 men and 13 women, mean age 37.9 +/- 8.6 years) with SIH completed the study. MRM did not differ from CTM in the detection rates of CSF leaks along the nerve roots (84% vs 74%, p = 0.23), high-cervical retrospinal CSF collections (32% vs 16%, p = 0.13), and epidural CSF collections (89% vs 79%, p = 0.20). MRM demonstrated more spinal levels of CSF leaks (2.2 +/- 1.7 vs 1.5 +/- 1.5, p = 0.011) and epidural collections (12.2 +/- 5.9 vs 7.1 +/- 5.8, p < 0.001) than CTM. The overall level-by-level concordance was substantial for CSF leaks along the nerve roots (C1-L3) (kappa = 0.71, p < 0.001, agreement = 95%) and high-cervical retrospinal CSF collections (C1-3) (kappa = 0.73, p < 0.001, agreement = 92%), and moderate for epidural CSF collections (C1-L3) (kappa = 0.47, p < 0.001, agreement = 72%). Ten of the 14 patients (71%) receiving targeted EBPs experienced sustained symptomatic relief after a single attempt.
Heavily T2-weighted magnetic resonance myelography was accurate in localizing CSF leaks for patients with spontaneous intracranial hypotension. This noninvasive technique may be an alternative to computed tomographic myelography before targeted epidural blood patches.
Background and purpose
The association between migraine and transient global amnesia (TGA) is not determined. Only two clinic‐based studies showed that TGA patients had a higher frequency of migraine ...history. Our population‐based study aimed to investigate whether migraine patients were associated with a higher risk of developing TGA.
Methods
Patients with migraine aged ≥18 years were identified from the Taiwan National Health Insurance Research Database between 2005 and 2009. Each migraine patient was randomly matched to one subject without migraine or other headache disorders based on age, sex and cardiovascular comorbidities. Patients with antecedent stroke, epilepsy or TGA were excluded. Both cohorts were followed up until the end of 2010. The incidence rates of TGA were compared and risk factors were identified.
Results
A total of 158 301 patients in the migraine cohort and 158 301 patients in the matched control cohort were enrolled. During a mean follow‐up of 3.0 years (range 0–6 years), the migraine cohort had a greater risk of developing TGA than the control cohort 7.59 vs. 3.06 per 100 000 person‐years, incidence rate ratio (IRR) = 2.48, P = 0.002. Compared with the matched cohort, only female migraine patients aged 40–60 years showed a significantly higher risk of TGA IRR = 3.18 (1.31–8.82), P = 0.005. Of note, the incidence rates did not differ between migraine patients with and without aura.
Conclusions
This population‐based study demonstrates that migraine is associated with an increased risk of TGA, particularly in female patients aged 40–60 years.
Objective: To explore the neuropsychiatric manifestations in patients with Alzheimer’s disease (AD) and cortical and subcortical vascular dementia (VaD). Methods: We investigated consecutive patients ...with dementia. All the participants received brain computed tomography. The diagnosis of dementia was confirmed by clinical criteria and the imaging findings. Only patients with probable AD, and subcortical and cortical VaD were included. The Mini Mental State Examination (MMSE) was used to evaluate global cognitive function, and the Neuropsychiatric Inventory (NPI) was used to assess neuropsychiatric symptoms. Results: Of the 536 participants with dementia, 320 (59.7%) had AD, 161 (30%) had subcortical VaD, 35 (6.4%) had cortical VaD, and 16 (2.9%) had mixed cortical and subcortical VaD. Cortical VaD patients had the highest mean composite NPI scores in all domains and AD patients had the lowest composite scores in most domains. The mean composite scores of the apathy and sleep disturbance domains in patients with cortical VaD were significantly higher than those in the patients with AD after controlling for years of education and MMSE score (p<0.01). Conclusions: There were few differences among the patients with AD, subcortical VaD and cortical VaD. The most consistent differences were the high sleep disturbance scores in those with cortical VaD.
Background
Cognition impairment is well known in patients with chronic kidney disease (CKD). The relationship between brain structure and cognitive performance in CKD patients is still under ...investigation. The study aimed to quantitatively assess the relationship between brain structure and cognitive performance in patients with CKD.
Methods
We recruited 39 patients with CKD and 39 age‐ and sex‐matched control participants from a tertiary medical center. All participants underwent 3‐T MRI scan neuropsychological assessments, and renal function tests. FreeSurfer software was used for imaging processing and analysis, including measurement of cortical thickness and gray matter (GM) and white matter volumes.
Results
Compared with control subjects (73.1±7.5 years old), patients with CKD (76.4±8.4 years old) had significantly lower scores on the Mini‐Mental State Examination, and forward digit span test (P<.01). Patients with CKD had smaller cerebral GM volume, hippocampus, and decreased cortical thickness (P<.01) relative to the control group. Estimated glomerular filtration rate (eGFR) was correlated with cognitive performance, cortical thickness, GM volume, and hippocampal volume (P<.001). Linear regression analysis revealed that eGFR and GM volume were independently negatively associated with cognitive performance (P<.001), while eGFR and age were negatively associated with cortical thinning and GM volume after controlling for confounding factors.
Conclusions
This study demonstrated that impaired kidney function is associated not only with poor cognitive performance, but also with small cerebral GM volume and reduced cortical thickness.
This study compared the effects of external hex, internal octagon, and internal Morse taper implant–abutment connections on the peri-implant bone level before and after the occlusal loading of dental ...implants. Periapical radiographs of 103 implants (63 patients) placed between 2002 and 2010 were collected, digitized, standardized, and classified into groups based on the type of implant–abutment connection. These radiographs were then analyzed with image-processing software to measure the peri-implant crestal bone change during the healing phase (4 months after implant placement) and at loading phases 1 and 2 (3 and 6 months after occlusal loading, respectively). A generalized estimating equation method was employed for statistical analysis. The amount of peri-implant crestal bone change differed significantly among all time–phase pairs for all 3 types of implant–abutment connection, being greater in the healing phase than in loading phase 1 or 2. However, the peri-implant crestal bone change did not differ significantly among the 3 types of implant–abutment connections during the healing phase, loading phase 1, or loading phase 2. This retrospective clinical study reveals that the design of the implant–abutment connection appears to have no significant impact on short-term peri-implant crestal bone change.
Cranial autonomic symptoms (CAS) are distinguishing features of trigeminal autonomic cephalalgias, of which cluster headache (CH) is the most common, but they can occur in patients with migraine. For ...migraine with strictly unilateral headache, the presence of CAS might cause diagnostic confusion with CH. Characteristics of CAS in migraine and comparisons with those in CH have rarely been reported.
This study prospectively recruited consecutive patients with migraine and CH treated at a headache clinic. Six CAS items were surveyed, including: conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, eyelid oedema and forehead/facial sweating. The CAS characteristics recorded included: laterality, intensity, time sequence and consistency with headache attacks.
A total of 786 migraine patients (625 women/161 men, mean age 40 (13) years) and 98 CH patients (11 women/87 men, mean age 36 (11) years) were recruited. The prevalence of > or =1 CAS in migraine patients was 56% and did not differ among migraine subtypes. Except for forehead/facial sweating, the features of the other CAS differed between patients with migraine and CH: CAS in migraine tended to be bilateral (OR 5.8-23.8 among different CAS), be unrestricted to the headache sides (OR 5.0-20.4), appear with mild to moderate intensity (OR 1.7-7.7) and be inconsistent with headache attacks (OR 2.8-6.7).
CAS were present in half of our migraine patients and the clinical features may help differentiate migraine from CH.
To investigate the clinical pictures of patients with recurrent thunderclap headaches of unknown etiology and to field-test two relevant International Classification of Headache Disorders, 2nd ...edition (ICHD-II) criteria, i.e., primary thunderclap headache (Code 4.6) and benign (or reversible) angiopathy of the CNS (Code 6.7.3).
We prospectively recruited patients presenting with idiopathic recurrent thunderclap headaches from a hospital-based headache clinic. Detailed histories, neurologic examinations, and MRIs and magnetic resonance angiographies (MRAs) were performed in all patients to exclude secondary causes. Patients with cerebral vasoconstriction received serial MRA follow-up.
Fifty-six consecutive patients (51 female/5 male, mean age 49.6 +/- 9.8 range 22 to 76 years) were enrolled. Segmental vasoconstriction (or benign CNS angiopathy) was found in 22 patients (39%). Thunderclap headache recurred in all patients with a median frequency of 0.7 times per day for a median period of 14 days (range 6 to 86 days). The median duration for each single attack was 3 hours. Most patients (84%) reported at least one trigger. Nimodipine effectively aborted further attacks in 83% of the treated patients. Headache attacks subsided within 3 months. Four patients (7%) developed ischemic complications. Patients with and without vasoconstriction based on MRA images were similar regarding demographics and headache profile. Except for the duration criterion, our patients generally mapped well into the proposed ICHD-II criteria.
This study suggests that the two diagnostic entities proposed by the ICHD-II may present different spectra of the same disorder. The distinct headache profile may help physicians quickly recognize this disabling headache disorder with risk of stroke and provide timely treatment.
Summary The survival rate of dental implants is markedly influenced by the quality of the bone into which they are placed. The purpose of this study was to determine the trabecular bone density at ...potential dental implant sites in different regions of the Chinese jawbone using computed tomography (CT) images. One hundred and fifty‐four potential implant sites (15 in the anterior mandible, 47 in the anterior maxilla, 55 in the posterior mandible, and 37 in the posterior maxilla) were selected from the jawbones of 62 humans. The data were subjected to statistical analysis to determine any correlation between bone density (in Hounsfield units, HU) and jawbone region using the Kruskal–Wallis test. The bone densities in the four regions decreased in the following order: anterior mandible (530 ± 161 HU, mean ± s.d.) ≅ anterior maxilla (516 ± 132 HU) > posterior mandible (359 ± 150 HU) ≅ posterior maxilla (332 ± 136 HU). The CT data demonstrate that trabecular bone density varies markedly with potential implant site in the anterior and posterior regions of the maxilla and mandible. These findings may provide the clinician with guidelines for dental implant surgical procedures (i.e., to determine whether a one‐stage or a two‐stage protocol is required).
We conducted a two-stage population-based headache survey among subjects aged ≥15 in Taipei, Taiwan. Subjects with chronic daily headache (CDH) in the past year were identified, interviewed and ...followed-up. CDH was defined as a headache frequency > 15 days/month, with a duration > 4 h/day. Of the 3377 participants, 108 (3.2%) fulfilled the criteria for CDH, with a higher prevalence in women (4.3%) than men (1.9%). TM was the most common subtype (55%), followed by CTTH (44%). Thirty-four per cent of the CDH subjects overused analgesics. At the 2-year follow-up, 35% of the CDH subjects still had CDH. The significant predictors for persistent CDH at follow-up included: older age (≥ 40 years) (RR = 2.4), CDH onset after 32 years (RR = 1.8), CDH duration ≥6 years (RR = 2.0), medication overuse (RR = 1.8), and ‘daily’ headache (RR = 2.1). We found that CDH is not uncommon in the community and its prevalence is similar among different populations. Older subjects and those with medication overuse may have a more protracted course of illness.
PDF
