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Pituitary apoplexy (PA) is a rare, potentially life-threatening condition primarily associated with pituitary adenomas. It presents with sudden, severe symptoms due to inadequate blood supply, bleeding, or tissue death in the pituitary gland. This case report describes a case of PA in a 40-year-old female, and reviews the recent literature surrounding the subject. The patient presented with complete bilateral third nerve palsy and dilated non-reactive pupils. Her initial symptoms included retroorbital headache, fever, and double vision, which rapidly progressed to oculomotor nerve palsy. MRI revealed hemorrhagic PA. High-dose steroids were initiated, leading to the resolution of ptosis. Additionally, surgical intervention was performed. PA typically affects older males with known adenomas, making this case unusual due to the patient's age, gender, and absence of prior adenoma history. Differentiating PA from other intracranial pathologies is crucial, and MRI plays a pivotal role in accurate diagnosis.

Pain is represented in the child and adolescent population all over the world, and many young adults have chronic pain. Chronic pain is accompanied by the lifestyle and functioning alteration, as well as by the development of depression and anxiety symptoms. The global prevalence of chronic pain among children varies between 20 and 40%, about 8% of children report frequent severe pain, and 5% of children and adolescents become disabled due to pain. Headache (HA) is a common complaint of children and adolescents: by the age of 3 years complaints of HA are reported in 3–8% of children, by the age of 5 years in 19.5%, by the age of 7 years in 37–51.5% of children. The prevalence of HA, regardless of the subtype, is almost the same in girls and boys under the age of 12 years. The main HA subtypes that occur in pediatric practice are as follows: migraine (with or without aura), tension-type HA, cluster HA. Pain, including HA, is often associated with mental disorders in children and adolescents. Thus, the study focused on assessing the relationship between HA and mental disorder in the representative sample (10,123 people) confirmed the association between HA, especially migraine, and mental disorders in adolescents. The strongest associations were reported between migraine and mood disorders and anxiety, behavioral disorders, and substance use. Young adults with HA, especially migraine, more often suffered from multiple mental disorders. The paper presents a clinical case of the 10-year-old girl with the autism spectrum disorder and the combination of migraine without aura and depressive disorder.

Introduction: Tension-type headache (TTH) is a common neurological disorder characterized by bilateral head pain and muscle tension, affecting up to 78% of the population. Despite its prevalence, TTH has historically received less attention than migraines. However, recent years have seen increased interest in understanding its pathophysiology and treatment options. This review comprehensively analyzes TTH management, covering non-pharmacological and pharmacological approaches to guide clinical practice and future research effectively. State of Knowledge: TTHs manifest as bilateral, pressing, encircling head pain, profoundly affecting individuals' quality of life. Recent years have witnessed increased interest in TTH understanding and treatment. Non-pharmacological interventions, including behavioral modifications, exercise, dietary adjustments, sleep hygiene, physical therapy, psychotherapy, and pharmacological treatments like over-the-counter medications, prophylactic drugs, psychedelics, and botulinum toxin A, have shown promise in alleviating symptoms. Conclusion: This review highlights the multifaceted management of TTH. Non-pharmacological interventions, including behavioral modifications and psychotherapy, offer symptom relief. Body awareness therapy, exercise, and psychotherapy benefit TTH symptoms and quality of life. Paracetamol, ibuprofen, and amitriptyline are standard treatments, with emerging options like psychedelics and botulinum toxin A. Personalizing treatment and understanding TTH mechanisms pose challenges. A multidisciplinary approach is essential for enhancing management and outcomes. More research is required to identify optimal treatments and long-term efficacy. Despite challenges, progress in TTH management brings hope for better patient care.

Introduction Tension-type headaches (TTH) are a significant health concern that demands precise diagnostic approaches and effective management strategies. A nuanced understanding of their pathophysiology and diagnostic challenges is not just pivotal, but a responsibility we share, for enhancing patient care. Aim This article aims to explore the complex realm of TTH diagnosis and management, underlining the need for precision in diagnostics and the intricate balance of cost-effectiveness. It also delves into the diverse therapeutic options available for treating TTH, presenting a stimulating challenge for healthcare professionals, researchers, and medical students. State of Knowledge Initial diagnosis involves excluding secondary headaches by identifying red flags indicative of serious underlying conditions. A detailed medical history, complemented by patient-recorded pain diaries, enhances diagnostic accuracy. Ancillary procedures like neuroimaging, despite cost-effectiveness debates, are often preferred by clinicians to mitigate diagnostic risks. Validated tools such as the MIDAS and HIT-6 questionnaires provide valuable insights into headache-related disability. Differential diagnosis among headache types relies on recognizing distinctive clinical features. Summary (Conclusions) Effectively managing TTH necessitates a multifaceted approach, incorporating pharmacological, non-pharmacological, and lifestyle interventions tailored to individual patient needs. Collaborative efforts spanning legal, technological, and research domains are crucial for advancing headache diagnostics and therapeutics. While technological advancements offer promise, interdisciplinary collaboration remains fundamental in optimizing patient care outcomes.

Background: Among the bacteria that affect the central nervous system, Listeria monocytogenes (facultative intracellular bacterium) is one of the most lethal to humans and animals. Listeriosis affects domestic and farm animals (pigs, small and large cattle, horses, rabbits, less often cats and dogs), as well as domestic and ornamental birds (geese, chickens, ducks, turkeys, pigeons, parrots and canaries). L. monocytogenes can be detected in fish and seafood (shrimp). The source of L. monocytogenes infection are animals in which the disease may manifest itself or occur in erased and asymptomatic forms followed by the transition to a long-term carriage. This pathogen is found throughout the world in foodstuffs, and most cases of infection occur through the ingestion of contaminated food. Particularly susceptible to the disease are embryos, newborns, the elderly and individuals with immunodeficiencies and chronic diseases. L. monocytogenes can cause intracranial hemorrhage, meningitis, meningoencephalitis, and rhombencephalitis. Clinical case description: This paper presents our own clinical observation of the development of severe listeriosis meningoencephalitis in a 47 year-old patient against the background of the new coronavirus infection (COVID-19). We describe the details of the clinical presentation, the treatment and the favorable outcome in our patient. Conclusion: Invasive listeriosis is a rare disease. The knowledge about the clinical manifestations of this disease is needed not only for epidemiologists and infectious disease specialists, but also for physicians of other specialties. Untimely diagnosis and inadequate antibacterial therapy are dangerous leading to severe somatic and neurological complications with a lethal outcome or disability both in children and adult persons.

Pain and sleep disorders are interrelated problems that significantly affect patients’ quality of life (QoL) and daily functioning.Objective: to evaluate the efficacy and safety of the use of the combination of diphenhydramine + naproxen (NOVEMA® NIGHT) in patients with acute pain syndrome or exacerbation of chronic pain syndrome and sleep disorders.Material and methods. The study included 4365 outpatients with acute pain (musculoskeletal pain, post-traumatic pain, headache) and sleep disorders who took naproxen 275 mg, 1 tablet in the morning and diphenhydramine 25 mg + naproxen 220 mg (NOVEMA® NIGHT) for 5 days before bedtime. Pain intensity, using a visual analogue scale (VAS), and sleep disorders were assessed before and after treatment; QoL was assessed after treatment using a five-point scale.Results. During treatment, a reduction or complete regression of pain was observed in 92% of cases (60 [50; 61] points on the VAS before treatment versus 10 [0; 20] after treatment; p

Introduction: Migraine remains one of the most prevalent chronic neurological conditions that significantly impacts the quality of life. The treatment aims to help with the symptoms and prevent further attacks. There are several pharmacological methods, but because of their side effects, sometimes lower-than-expected effectiveness, costs, and long-term dependency, non-pharmacological approaches have gained popularity. Review methods: We conducted our study as a literature review, with data gathered via PubMed and Embase. The state of knowledge: Managing migraine is hard to achieve based only on pharmacological therapy. Recently, the development of alternative approaches, such as cognitive behavioral therapy, acupuncture, or butterbur, has been observed. Many studies try to assess its effectiveness. Biofeedback is a promising treatment method, however, it is expensive and requires special equipment. Aerobic training is essential in the prevention and therapy of many illnesses and proper intensity can be helpful with migraines, while yoga is a great lower-intensity option. Conclusions: Alternative methods may be a great alternative or support in migraine management. However, there is still a need for standardized investigations to evaluate effectiveness and safety.

Headache and dizziness are the two most common complaints with which patients turn to physicians of various specialties. A thorough examination often reveals a combination of these two symptoms. Currently, the term “vestibular migraine” (VM) is recognized by the worldwide community of otoneurologists and neurologists as the most appropriate for the combination of vestibular vertigo and migraine headaches. The difficulties in diagnosis and differential diagnosis are related to the lack of possibility to confirm the disease (and to detect) instrumentally and to the fact that the dizziness may be different in different VM episodes, even in one patient. The complexity of therapy is in the need to choose a relatively individualized treatment regimen and in the lack of an ideal vestibular suppressant (which quickly suppresses dizziness and has no significant side effects). In this context, finding the most effective drugs for emergency and elective treatment of patients with VM is undoubtedly important. For patients with VM, the use of the drug Arlevert (dimenhydrinate 40 mg + cinnarizine 20 mg) can be recommended for the relief of acute vestibular crisis at home, since the drug is highly effective and well tolerated. In addition, and most importantly, Arlevert has no known interactions with other medications used for migraine prevention.

Transcranial magnetic stimulation (TMS) is increasingly used in research and clinical practice, therefore, the issues of its safety and tolerability are especially important. Currently, serious adverse reactions (ARs) are extremely rare. The more common mild ARs that can develop during and after stimulation remain less well understood but may affect procedure tolerance and treatment adherence.Objective: to study the tolerability and safety of TMS in patients and healthy volunteers.Material and methods. In a retrospective cohort study using standardized questionnaires, ARs were assessed during and within 24 hours after TMS in patients (n=103) and healthy volunteers (n=74).Results. In total, the data of 1246 sessions were analyzed. ARs were observed during 56.8% of the analyzed sessions and within 24 hours after in 21.5% of the sessions. In most cases, they were mild and did not affect the intent to continue stimulation. TMS withdrawal due to ARs was reported in six cases (3.3% of participants), three of which experienced severe headache (HA) after stimulation. During stimulation, sleepiness (32.4%) and pain in the stimulation area (20.3%) were most often recorded. The most frequent AR within 24 hours after TMS was HA (13.3% of sessions), its characteristics are described and possible diagnostic criteria are proposed.Conclusion. ARs can occur during and after a TMS session and are mild in most cases. TMS-induced HA, which is the most common AR within 24 hours after TMS, can be considered a distinct type of secondary HA, the pathogenesis of which requires further study.

Introduction: In today's fast-paced life, an increasing number of people are experiencing chronic stress, which negatively impacts our mental and physical health, leading to troublesome conditions such as primary headaches. Faced with this challenge, more individuals are turning their attention to mindfulness techniques as an effective tool for stress management. In light of this, mindfulness, focusing on the awareness of the present moment, emerges as a promising method for preventing and alleviating stress-induced headaches and the resulting aftermath. Purpose: Offer a comprehensive overview of the current understanding of the efficacy of mindfulness training, particularly Mindfulness-Based Stress Reduction (MBSR), in the prevention and relief of primary headaches and their associated consequences. Description of the state of knowledge: MBSR demonstrates the potential for effectively coping with stress-induced headaches and their subsequent effects, including disability related to headaches. This category of pain includes conditions like migraine and tension-type headaches. In the clinical trials conducted thus far participants in the MBSR program show noticeable improvement in headache-related disability, self-efficacy, quality of life, catastrophic pain, and depression scores. Summary: Studies suggest that integrating mindfulness training could present a promising strategy for preventing and reducing the severity of primary headaches and their consequences, by mitigating stress, a crucial factor influencing the onset of these headaches. To validate these promising findings, further randomized, large-scale, placebo-controlled studies are required.

Chronic migraine is a disease that significantly reduces the quality of life of patients. It affects millions of people around the world, and is common particularly among young women. Family physicians often encounter the problem of migraine headaches in their daily practice. The diagnostic problem results from absence of tests or imaging studies that can clearly indicate the cause of the headache. In order to establish a diagnosis and exclude secondary sources of pain, doctors focus on a detailed medical history and analysis of symptoms presented over time. Preventive treatment of migraine requires appropriate drug selection after weighing the benefits and risks for each patient. This review paper presents and briefly discusses selected pharmacological and non-pharmacological methods used in migraine prevention. They were selected by searching the PubMed Internet database. The presented non-pharmacological methods include the use of nutraceutics, acupuncture and behavioral therapy. The discussed pharmacological methods include treatment with beta-blockers, topimarate, flunarizine or one of the latest methods - the use of monoclonal antibodies against CGRP. In addition, the use of botulinum toxin type A in the treatment of chronic migraine has also been demonstrated. It should be remembered that the type of therapy chosen should be individualized: according to the patient's preferences, treatment effectiveness, possible side effects or accompanying diseases. Proper management of chronic migraine prophylaxis can significantly improve the quality of life of patients and reduce the frequency of headache attacks.

Headache is the leading syndrome of many diseases caused by a polluted environment. Processing of human waste reduces the negative impact of landfills of human health. The conducted survey of residents of Vinnytsia and Ternopil found that the vast majority (99 %) of respondents understand that environmental pollution poses a threat to health, causes many diseases accompanied by headaches and requires a solution to waste disposal. Almost all respondents (93 %) are ready to sort garbage, provided the appropriate conditions are provided, which are improve the environment and help reduce the prevalence of headache syndrome in the human population

This article presents a review of current modern research on the use of botulinum toxin therapy for the prevention and treatment of patients with chronic migraine, as well as briefly outlines current views on the pathogenesis of migraine, its impact on quality of life and patients' ability to work. Botulinum toxin A is currently the drug of first choice for the treatment of chronic migraine. Numerous studies confirm the effectiveness and safety of its use in clinical practice.

Headache, which is often present in patients with epilepsy, can occur outside of epileptic seizures as well as have a temporary connection with them – occur immediately before, during or after an attack. Clinical types of headache in epilepsy are considered in the International Classification of Headache, but not in the classification of epileptic seizures and types of epilepsy. Meanwhile, the presence of concomitant headache and its clinical phenotype should be taken into account when choosing treatment tactics in patients with epilepsy. The article presents data on the prevalence of different types of headache in patients with epilepsy and a modern classification of cephalalgia depending on the temporal relationship with an epileptic attack. Diagnostic criteria for four clinical variants of cephalgia are given: interictal, preictal, ictal and postictal. The comorbid relationship between epilepsy and migraine is considered in more detail, including the pathophysiological mechanisms underlying the combination of these paroxysmal conditions.

Background. Today, tumors of the central nervous system are the leading cause of mortality among pediatric cancers, and the region of the posterior cranial fossa (PCF) is one of the most common localizations. Despite availability of neuroimaging methods, such pediatric tumors are diagnosed long after the onset of appropriate symptoms. Aim. To assess the posterior cranial fossa tumor diagnosis time, initial complaints and symptoms, as well as the events occurring between the advent of complaints and the diagnosis. Methods. The pre-hospital and outpatient care reports of 79 children, who underwent surgery due to intracranial tumors of the posterior cranial fossa in the Burdenko National Medical Research Center of Neurosurgery in 2021-2023, were assessed. The possible causes of delayed proper diagnosis were analyzed. Results. Headache is the main reason for seeking medical care, however, it seldom becomes the reason for magnetic resonance imaging (MRI) in children. The average time between the onset of symptoms and the diagnosis of the PCF tumor is almost 4.5 months. In 37.9% of cases, the MRI scan was the initiative of the patients' parents, and the parents' time frame of independent decision making did not differ from the time frame of the physician's decision to send a child with appropriate symptoms for MRI. In other words, neuroimaging was performed when the condition worsened, and worsening was obvious for anybody without medical training. The low level of concern in primary care providers and the significant systemic causes that slow down the diagnosis are among the reasons of such a long wait for the diagnosis.

Primary vasculitis of the central nervous system (PACNS) is a rare form of unknown cause vasculitis that affects the vessels of the brain, spinal cord and meninges without systemic damage. It was found that the average age of the onset of the disease was 50 years. Clinical manifestations depend on the caliber of the affected vessels. The most common initial symptoms are headache and vascular cognitive impairment associated with small vessel involvement. The development of stroke and focal symptoms is interrelated with vascular cognitive impairment and manifests as the lesion of the middle/large cerebral arteries. PACNS is difficult to diagnose, since symptoms of vasculitis outside the central nervous system are rare, serologic markers of inflammation are normal. The analysis of cerebrospinal fluid is usually abnormal due to a moderate nonspecific increase in the level of total protein or the number of leukocytes. Deviations from the norm (cerebral infarction, sometimes tumor-like lesions) are detected according to the data of magnetic resonance imaging of the brain in 97 % of patients with PACNS. Angiography has low sensitivity and low specificity, since it allows to verify vasculitis of only middle and large cerebral arteries, revealing segmental narrowing. To detect inflammation of the blood vessels, as well as to exclude other diseases, it is necessary to perform a biopsy of the substance and the soft membranes of the brain.

Introduction. Brain tumours constitute approximately 1% of all newly diagnosed cancers. Their manifestation typically involves headache, neurological impairment, focal onset seizures and syndromes related to tumour location. Severe headache presents as a prevailing symptom and occurs in over 50% of patients. Brain tumour associated headache exerts significant effect on quality of life in cancer patients. The following article aims to provide a comprehensive overview of most common and promising brain tumour related headache treatment strategies. State of knowledge. Headache in brain tumour patients arises from traction or displacement of intracranial pain-sensitive structures, such as vascular tissue, dura mater or periosteum. This can be caused by tumour’s mass itself, by tumour associated oedema or as a sequela of anti-tumour treatment. Most common therapeutic modalities include tumour surgical resection, cerebral oedema management, radiotherapeutic interventions and administration of analgesic agents. Complete removal of the tumour stands as the most effective approach, often bringing substantial alleviation in majority of cases. Conclusion. Headache affects the majority of individuals afflicted by brain tumours. Not all patients are suitable candidates for the resection of the underlying neoplasm. In such instances, the application of alternative approaches might be beneficial. Ongoing and future investigations may enhance the development of novel treatment strategies, possibly influencing the well-being of cancer patients, especially within palliative care area.

Migraine is one of the leading causes of disability in humans. It causes significant deterioration in patients' lives and prevents daily functioning. Its main symptoms include photophobia, an enormous stabbing headache, nausea and vomiting. In addition, it can be accompanied by tinnitus, visual disturbances or dizziness. Before diagnosing migraine, serious intracranial pathology or other neurological conditions should be ruled out. Treatment of acute migraine is difficult due to significant rates of nonresponse to medications and the difficulty in predicting individual response to a particular agent or dose. A new class of drugs, calcitonin gene-related peptide (CGRP) antagonists, has been approved for the prevention of migraine in adults. In contrast, effective first-line therapies for mild to moderate migraine are over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) and combination analgesics containing paracetamol, aspirin and caffeine.

Background. Obesity is a component of metabolic syndrome, a separate disease, and a predictor of most chronic diseases. In recent decades, increasing attention has been paid to the effect of obesity on chronic localized pain. Aim. To determine the clinical characteristics of chronic localized pain depending on the body mass index and sociodemographic factors. Materials and methods. The study enrolled 112 eligible patients, 37 (33%) males and 75 (67%) females aged 19 to 65 years, with a mean age of 40 [32; 40] years. Patients were divided into three groups depending on the body mass index. All patients underwent a comprehensive general clinical examination, including an assessment of the pain prevalence and duration, the number of exacerbations in the current year, the pain severity using the Numeric Pain Rating Scale (NPRS), and the number of pain descriptors. Results. Obese patients experience more severe pain (p=0.004), are prone to prolonged (p=0.010) and frequent exacerbations (p=0.004), and use more lexical units to describe the pain (p=0.001). The main pain sites associated with obesity are the upper (p=0.023) and lower extremities (p=0.002). The overweight group falls between obese subjects and those with normal body weight and, by many parameters, is similar to the normal body weight group. It was noted that age worsens the pain; thus, with age, the number of exacerbations per year (p=0.006) and the duration of exacerbations (p=0.016) increase, and a direct correlation of age with the pain prevalence and the number of descriptors was revealed (r=0.271; p=0.004 and r=0.267; p=0.004, respectively). The most severe pain occurs in females. In contrast, physical activity reduces the number and duration of exacerbations and the prevalence of pain (p=0.004; p=0.048; p=0.015, respectively). Conclusion. Obesity, older age, and female gender are associated with more severe chronic pain. Body weight loss in obese patients with pain, as well as lifestyle modification with increased physical activity, is an essential aspect of overall rehabilitation, although additional studies are needed to establish strategies for maintaining long-term effects.

Recurrent painful ophthalmoplegic neuropathy is a rare clinical syndrome, included into the International Classification of Headache Disorders, 3rd edition, and characterized by recurrent headache episodes associated with dysfunction of one or more ocular motor nerves. The diagnosis implies mandatory exclusion of other potential causes of the symptoms. The paper presents a clinical case of a 49-year old female patient with a unilateral headache paroxysms and subsequent paresis of the oculomotor nerve. A thorough clinical assessment, with neuroimaging (brain magnetic resonance imaging and magnetic resonance angiography of arteries and veins of the head) showed no morphological abnormalities that could cause clinical symptoms of oculomotor neuropathy. Her past history was remarkable for a similar episode of prolonged unilateral headache and oculomotor paresis about 10 years before, which were at that time considered as an acute cerebrovascular accident. Thus, two episodes of similar clinical signs of painful neuropathy, the absence of other possible causes of the disease, and the complete regression of symptoms after treatment (ibuprofen and gabapentin) confirmed the diagnosis of recurrent painful ophthalmoplegic neuropathy.

INTRODUCTION. Diagnosis and treatment of headache in pediatric patients is of priority medical and social importance, including when correcting it at the sanatorium and health resort stage. Difficulties and problems are associated with the complexity of taking an anamnesis in children, incorrect diagnosis, comorbidity, the need for timely correction of risk factors, and the appointment of the effective pathogenetically proved treatment. AIM. To determine the structure and features of the cephalgic syndrome in pediatric patients undergoing treatment in Evpatoria sanatoriums and to determine the effectiveness of psychological correction in the treatment of patients with frequent tension-type headache by using the method of music therapy method. MATERIAL AND METHODS. As a result of a complex examination of pediatric patients, 150 patients with headache complaints were selected out of 513 examined by the method of simple random sampling. Together with a psychologist, a subgroup of 30 patients with frequent tension headaches was selected from the total number of patients after psychological testing for whom music therapy was included in the treatment plan. RESULTS AND DISCUSSION. In the structure of the cephalgic syndrome the prevalence of tension headache was revealed, while 20% of patients had frequent episodic tension headache against the background of increased anxiety and fatigability, which significantly affects quality of life and social functioning. The patients who underwent correction of tension headaches by music therapy showed improvement of extraversion indices, reduction of neuroticism, decrease of anxiety, fatigability and irritability indices, decrease of frequencyand intensity of headaches. None of the patients were diagnosed with headache according to ICHD-III in the referral diagnosis for sanatorium treatment, but were diagnosed with vegetative-vascular dystonia and other comorbidities. CONCLUSION. The obtained data of a complex examination made it possible to substantiate a pathogenetically differentiated rehabilitation course in sanatorium treatment and led to an increase in the efficiency and quality of treatment for each patient. Using the method of music therapy, emotional and psychological correction was carried out, which occupies an important place in the relief of headache in pediatric patients.

Introduction. Valproic acid and metamizole are widely used in the treatment of primary headaches. However, despite the drugs’ proven clinical efficacy, the neurophysiological mechanisms underlying their therapeutic action are poorly understood. The ventral posteromedial nucleus of the thalamus (VPM) serves as the highest suprasegmental relay center for transmitting ascending nociceptive information from the cranial structures to the cerebral cortex and is considered as a potential neuroanatomical target for anticephalalgic drugs.The objective of the study was to evaluate the action of valproate and metamizole on the excitability of the VPM thalamic neurons.Methods and materials. In acute controlled experiments on anesthetized rats (n=31), we studied the action of cumulative dosing (three fixed dose injections every 30 minutes) of intravenously administered valproate (n=8, 100 mg/kg x 3) or metamizole (n=16,150 mg/kg · 3) on extracellularly recorded background and dura mater electrical stimulation-evoked activities of the convergent VPM neurons. Results. In all experiments, intravenous valproate significantly inhibited both background activity of the VPM neurons and their responses to dural electrostimulation. Metamizole had a similar action in more than half of the cases, whereas 44 % of the examined thalamic cells (7 out of 16) did not react to its infusion.Conclusion. One of the main neurophysiological mechanisms underlying anticephalalgic action of valproic acid and metamizole may be inhibition of the nociceptive transmission at the thalamic level due to the drugs-induced suppression of the meningeal-sensitive VPM neurons excitability.

Doctors of various specialties face orofacial pain in their practice: dentists, maxillofacial surgeons, neurologists, otorhinolaryngologists, therapists, traumatologists, ophthalmologists, psychotherapists, physiotherapists, aesthetic medicine doctors, neurosurgeons, anesthesiologists, plastic surgeons and other specialists. The novel coronavirus infection (COVID-19) pandemic, spread by the SARS-CoV-2 virus, has become a challenge for all medical specialties and health care systems around the world. We searched the literature for the period from the beginning of the pandemic until June 15, 2022, on the study of the association of orofacial pain with a new coronavirus infection COVID-19 in the electronic search engines PubMed and Scopus. An analysis of the sources found indicates an increase in the frequency of various types of orofacial pain during the COVID-19 pandemic, which is due both to the SARS-CoV-2 infection itself and to a complex of biopsychosocial factors directly related to the pandemic. A number of used drugs, primarily non-steroidal anti-inflammatory drugs, can cause a number of side effects that complicate both dental treatment and negatively affect concomitant comorbid pathology. In this regard, the issues of drug safety and pharmacological "correction" of side effects – protective or protector therapy – become relevant. The use of the universal gastro- and enteroprotector rebamipide is especially important during the pandemic of a new coronavirus infection (COVID-19).

Relevance. Damage to the nervous system during the progression of systemic lupus erythematosus (SLE) is not only one of the most common phenomena, but also an unfavorable prognostic criterion for the patient. At the moment, more than 19 types of neurolupus manifestations are known in both adult patients and children. The main problem is the non-specificity and variability of neuropsychiatric symptoms, which can be associated not only with the pathogenesis of SLE, but also with other factors caused by the influence of the environment, psychosomatics, and concomitant diseases. Currently, there is no "gold standard" for diagnosing this type of pathology, and sometimes the selection of therapy does not correspond to the etiology of the lesion. Also, the urgency of this problem proves the lack of a clear classification of neurological complications of SLE, which can be used by specialists at the present time. The links of the pathogenesis of the development of both systemic lupus erythematosus itself and lesions of the nervous system in this disease are not fully understood. The purpose of this study. To study the pathogenesis and symptomatic manifestations of neurolupus, presented in the studies of Russian and foreign scientists, with the subsequent systematization of the information obtained. Material and methods. A study was made of materials from foreign and domestic literature of recent years on the issue of classification, pathogenetic and symptomatic problems of the neurological manifestation of systemic lupus erythematosus. Results. The prevalence of neurolupus among SLE patients reaches 95% of cases, expressed both in a single syndrome and in multiple simultaneous clinical manifestations. Lesions of both the central and peripheral nervous systems, as well as psychological disorders, are caused by the toxic effect of actively produced cytokines and interleukins, the deposition of immune complexes and thrombotic vasculitis, an increase in the BBB permeability and the penetration of autoantibodies tropic to the structures of the nervous tissue through it. At the moment, the classification of 2018 most fully covers all possible morphological manifestations of neurolupus, highlighting focal and diffuse lesions of the central nervous system, as well as peripheral. The most common occurrence among SLE patients is headache, which is not a specific manifestation, strokes, aseptic encephalomyelitis, cognitive disorders and depression. Conclusions. Neurolupus is a very common and poorly understood complication of systemic lupus erythematosus, which needs more detailed coverage in the medical literature. With a wide polymorphism of clinical manifestations, the neuropsychiatric syndrome of SLE is a real threat to the patient's life. The lack of a clear classification in clinical guidelines, huge gaps in knowledge about the pathogenesis of nervous pathologies, the similarity of the clinical picture of other diseases and the undeveloped diagnostic tactics of this pathology can lead to ineffectiveness of the therapy, irreversible damage to the nervous tissue and even death.

Migraine is a nervous system disorder that affects 7.7% of children and can debut before the age of 3 years. As they get older, the incidence of migraine increases, and among adolescents, its prevalence reaches 15%. The disease can significantly reduce the child's daily activity, school performance. Migraine is the most common cause of headache in children and adolescents, but it is not always diagnosed; it is not uncommon for patients with migraine to be misdiagnosed and given ineffective treatment. An effective approach to the diagnosis of migraine in children is presented, diagnostic criteria for migraine according to the 3rd edition of International Classification of Headache Disorders are described. Special disorders in childhood are described – episodic syndromes in children associated with migraine. Migraine treatment in children includes four main approaches: 1) lifestyle recommendations; 2) migraine attack treatment; 3) nonpharmacological treatment; 4) migraine preventive pharmacotherapy. All of the listed approaches for the treatment of migraine in childhood are discussed in detail.

Introduction Nowadays it is pointed out how important it is to take care of both mental and physical health. It is also undeniable that one affects the other and vice versa. That is why it is so important to nurture your body. Yoga as one of the physical activities has a proven effect on psychosomatic symptoms. Yoga is increasingly recommended mainly to relieve anxiety or stress. It brings great solace and even greater attentiveness. Lifestyle activities are increasingly considered an important component of treatment. State of knowledge Medical conditions such as dementia, Parkinson's disease, headaches, PTSD, depression are mainly treated with drugs. Yoga, as a non-pharmacological treatment, alleviates psychological conditions, as it reduces stress, anxiety, depressive symptoms, and enhances attentiveness to one's self, self-control and a different perspective on traumatic situations. Conclusions A review of the following works has shown the effects of yoga on mental health and common neurological conditions. With regular practice, it is possible to develop cognitive function, reduce the intensity and frequency of headaches. In Parkinson's disease, mindfulness exercises lead to an increase in muscle strength, a decrease in muscle tremors, and therefore improved rehabilitation. Most of the examples below mention a decrease in anxiety, stress, depressive symptoms and an increase in mindfulness, greater emotional and physical flexibility. The works cited point out that more in-depth research is needed to delve deeper into the effects of yoga on health.

Cluster headache is characterized by specifically intense pain when compared to other types of headache. About 1020% of patients report no effect from conservative therapy. Research in this area has led to the use of sphenopalatine ganglion stimulation. The authors provide an up-to-date review of this method, how to select suitable patients, indications for surgery, determining its efficacy, and the risk of complications. The article presents a clinical case of a patient with cluster headache who was implanted with a stimulation system and followed up for 17 months.

Since the start of the COVID-19 pandemic scientists from all over the world have been working thoroughly to study this disease and its connections with other pathological conditions. In this review the specificity of headache in patients who had had COVID-19 infection in terms of differential diagnosis is estimated. Due to increasing amount of cases, this information will be extremely helpful for doctors who are managing such patient as well as for headache specialists.

In the practice of neurologists and therapists, patients with complaints of headache, increased fatigue, and irritability are common. The most frequent causes of headaches in ambulatory patients are primary headaches (migraine and tension headaches). Lack of sleep, stress, symptoms of anxiety and depression, and abuse of analgesic drugs are the most common factors that contribute to the frequency of headaches. Magnesium deficiency is another factor, the role of which has been discussed in the frequency of primary headaches, in the development of neurotic disorders and depression. Clinical manifestations of magnesium deficiency itself usually include such nonspecific symptoms as fatigue, anxiety, irritability, numbness in the extremities, leg cramps, sleep disorders, etc.Magnesium deficiency is widespread among the population of developed countries, especially among women of reproductive age, often occurs during pregnancy, while taking oral contraceptives. Magnesium is involved in the regulation of the nervous system, neuromuscular transmission, cardiac activity, regulation of vascular tone, blood clotting and bone tissue metabolism. Magnesium deficiency is associated with diseases such as coronary heart disease, hypertension, type 2 diabetes, Alzheimer’s disease, migraine, osteoporosis, depression, neurotic disorders (panic disorder, generalized anxiety, various phobias), and fibromyalgia syndrome. Stress can lead to a decrease in magnesium levels in the body, and magnesium deficiency, in turn, reduces tolerance to stressful situations. Timely diagnosis and adequate treatment of magnesium deficiency and associated conditions represent important clinical challenges.The clinical case of a patient with neurotic disorder, headache and magnesium deficiency is presented, and the effectiveness of an interdisciplinary approach including an educational talk, adequate therapy for headache management, magnesium drug therapy and psychological methods is demonstrated. The role of magnesium deficiency in the development of various neurologic diseases is reviewed. The most effective magnesium compounds for therapy are discussed. Principles of diagnosis and treatment of patients with magnesium deficiency are presented.

Migraine and sleep disorders are common in the general population, may be associated with each other and often significantly reduce patients’ quality of life. Clinicians and epidemiological studies have long acknowledged a link between these conditions. However, the exact nature of this relationship, its underlying mechanisms and patterns are complex and not fully understood. This publication brings together the latest data on the relationship between migraine and sleep disorders: the biochemical and functional-anatomical background, the mutual influence of these conditions on each other and the typical sleep disturbances in migraine patients (such as insomnia, obstructive sleep apnea, parasomnia, snoring, excessive daytime sleepiness). The paper discusses the hypotheses of pathogenetic relationships based on the studies of the central nervous system’s anatomical and physiological features in people with migraine and sleep disorders. The available data should encourage physicians to evaluate sleep quality in migraineurs and use combination therapy systematically. The therapy of insomnia is reviewed: both nonpharmacological and pharmacological therapies are discussed; the advantages of an integrated approach are discussed, and a brief overview of each group of medications is offered.Lastly, a case study of a patient with chronic migraine and insomnia treated with Doxylamine in combination therapy is presented. Treatment with Doxylamine significantly reduced the incidence of insomnia, probably thereby positively influencing the course of migraine as well.

Today, chronic cerebral ischemia (CCI) is the most common diagnosis in our country, both in neurological and general medical practice. The high frequency of comorbid conditions and diseases predisposing to the development of CCI, and the association with the risk of stroke and dementia, which increase patient disability, make CCI an urgent medical and social problem. Proper diagnosis of CCI allows the prescription of effective treatment, prevents the disease progression, and the development of strokes and dementia. The article deals with the treatment principles for elderly and senile patients with headache and CCI in outpatient practice. It discusses the causes of headache in CCI patients and its treatment methods. It also covers in depth the spectrum of therapeutic effects of Neurox® (ethylmethylhydroxypyridine succinate) and Neupilept® (citicoline) in this category of patients.

The paper presents experts' opinion on the clinical manifestations and diagnosis of chronic cerebrovascular disease (CVD) (chronic cerebral ischemia (CCI) and dyscirculatory encephalopathy (DEP)) at the pre-dementia stage. It is noted that DEP/CCI is a common diagnosis in Russian neurological practice, the criteria for which have not been updated for a long time. DEP/CCI most often develops in the presence of cerebral small artery (CSA) disease (cerebral microangiopathy (CMA)), the severity of which can be quantified by magnetic resonance imaging. The main clinical manifestation of DEP/CCI is cognitive impairment that may be subjective or moderate at the pre-dementia stage. Emotional disorders (apathy, depression, anxiety) and instability are considered as possible manifestations of CSA disease. It is noted that headache and vestibular vertigo are not caused by chronic CVD; while in patients with CMA, they are usually associated with other diseases (primary headache, peripheral vestibular vertigo, and vestibular migraine). The diagnosis of DEP/CCI should be based on the presence of cognitive impairment, reliable neuroimaging signs of CVD, and the exclusion of another cause of cognitive impairment.

Patients with migraine and signs of leukoencephalopathy are frequently found to have cognitive impairment (CI), the pathogenesis of which is not entirely clear. The dynamics of CI in these patients during preventive therapy has been little studied.Patients and methods. A six-month follow-up study was conducted in 50 patients (8 men and 42 women; mean age, 41.9±11.9 years) with migraine (mainly chronic one) and signs of cerebral leukoencephalopathy according to magnetic resonance imaging (MRI). A control group consisted of 40 healthy individuals (13 males and 27 females) aged 20 to 64 years (mean age, 42.6±12.0 years). Neuropsychological examinations (the 12-word recall test; the test of literal and categorical associations; the Benton visual retention test, the Munsterberg test; the Montreal Cognitive Assessment (MoCA), the trail making test; the forward and backward digit recall test; the digit-symbol coding test; and the Stroop color test) and studies of emotional disorders (the Beck Depression Inventory (BDI), the Center for Epidemiological Studies Depression Scale (CES-D); the Hospital Anxiety and Depression Scale (HADS), and the Spielberger-Khanin Scale) were performed at baseline, and at 3 and 6 months of preventive therapy for migraine.Results and discussion. The patients with migraine versus the control group were observed to have lower scores of the MoCA (p=0.004), the 12- word recall test (p=0.0003), and the tests of literal (p=0.001) and categorical (p=0.0002) associations. No significant relationship was found between the volume of MRI cerebral white matter lesions and the severity of CI. There was a moderate inverse correlation (correlation coefficient R=-0.41) between the number of headache (HA) days per month and the MoCA score (p

Aim. To demonstrate clinical cases of rare stroke type - cerebral venous thrombosis with paroxysmal conditions.Materials and methods. There were retrospectively analyzed medical histories of the three male patients at age of 19, 22 and 47 years old, respectively, diagnosed with venous stroke, and admitted at different time points to the Neurology Department managing acute cerebrovascular accidents.Results. Patients with subacute and acute venous stroke suffered from headache and general discomfort. Depression of consciousness and paroxysmal events were observed during acute stage of the disease. No elevated arterial blood pressure was found. Focal neurological symptoms were observed in one out of three patients manifested as aphasic disorders. Neuro-ophthalmological examination revealed signs of swelling in the optic nerve (papilledema) and retinal artery spasm. Risk factors predisposing to such pathology were revealed in each clinical case.Conclusions. Here we provided with most high-priority risk factors as well as initial clinical manifestations for developing cerebral venous thrombosis as a rather rare pathological condition. However, various issues related to it still remain and require further investigations.

Vestibular migraine is one of the most common causes of rotational vertigo, which, however, remains hard to diagnose a nosological entity. There will be discussed pathophysiological mechanisms and current therapeutic approaches along with epidemiology and diagnostic principles for vestibular migraine, which will be of value for hospital and out-patient neurologists as well as general practitioners.

Introduction.Magnetic resonance imaging (MRI) in patients with migraines often reveals structural brain changes of an unclear aetiology. The effect of these changes on the patients management plan requires further investigation. Theaimof the study was to analyse the management of patients with migraine, in whom structural brain changes were detected on MRI and the validity of MRI referral for migraine. Materials and methods.We examined 50 patients (8 men and 42 women, average age 41.9 11.9 years) with migraine (mainly chronic) and changes on brain MRI. We compared clinical and MRI data, analysed typical medical practice, and conducted a prospective follow-up of the patients for 6 months, during which preventive therapy was administered. Results.Most patients (78%) had predominantly white matter damage of the cerebral hypoperfusion type. None of the patients had indications for MRI. Misinterpretation of the changes on MRI led to most patients (86%) being mistakenly diagnosed with another disease (mainly chronic brain ischaemia) and prescribed inappropriate treatment. Six months of patient follow-up showed the effectiveness of preventive migraine therapy, with a reduction in headache frequency from 19.4 2.9 to 12.6 4.4 days per month (p 0.05). Conclusion. We found unreasonable referrals for brain MRI because of migraine, widespread misinterpretation of MRI changes, and an erroneous diagnosis of cerebrovascular changes as the cause of the migraines.

WHO estimates that the prevalence of headaches worldwide in the adult population is approximately 50 %. Globally, half to three­quarters of people aged 18 to 65 have complained of headaches in the past year, and more than 30 percent have suffered from migraines. At the same time, 1.7 to 4 % of the adult population suffers from head­aches that last 15 or more days a month. Undoubtedly, cephalgia constitutes a global problem. However, it is worrying that the causes of headaches are not always correctly diagnosed. The main clinical barrier pointed out by WHO is the lack of knowledge of health pro­fessionals about headache management. Thus, the broad coverage of issues related to the management of patients with cephalgia does not lose its relevance, and even more: it needs to be supplemented with current data. In particular, the mechanisms of headache can be associated with several pathophysiological processes that are triggered by the in­fluence of professional activities, specific physical activity, active leisure, or amateur sports. Recreational diving has become a popular form of active leisure for the past 20 years. It is noteworthy that headache is a common symptom in divers and, although it is usually benign, it can sometimes signal the serious consequences of high pressure. Proper diagnostic tactics require specialists to carefully collect the anamnesis and examine the patient, as well as to understand the unique physiological changes in the human body that occur under the influence of under­water environmental factors.

Objective: to comparatively evaluate the clinical efficiency of cervicocranialgia therapy with dexketoprofen (flamadex) and tolperisone (calmyrex), as well as with their combination. Patients and methods. The investigation enrolled 90 patients aged 30–60 years with cervicocranialgia, who were randomized into three equal groups. Group 1 included 7 men and 23 women who took dexketoprofen; Group 2 consisted of 13 men and 17 women who were prescribed dexketoprofen and tolperisone; Group 3 comprised 18 men and 12 women who used tolperisone. The three patient groups underwent assessment of the intensity of pain on a visual analogue scale and the degree of muscle tone on a 3-point scale and evaluation of the efficiency of therapy and the hemodynamic effect of the drugs in the common carotid and vertebral arteries. Results and discussion. In all the groups, their treatment reversed neck pain, headache, and dizziness, normalized muscle tone, and improved hemodynamics in the carotid and vertebral arteries. The effect was more pronounced in patients receiving combination treatment (Group 2). The therapy showed a high safety and a good tolerability. Conclusion. Dexketoprofen and tolperisone have been demonstrated to be effective and safe in treating cervicocranialgia.

Introduction. We present the results of our own observational cohort study of patients with stage I-II discirculatory encephalopathy treated with a combination of dihydroergocriptine and caffeine (Vazobral®). Interest in this issue is due to the fact that cerebrospinal venous insufficiency plays a role in the pathogenesis of neurodegenerative and vascular diseases of the brain, leading to the development of cognitive impairment, the formation of secondary headaches, and reducing the quality of life of patients.The purpose of the study was to evaluate the effectiveness and safety of the drug Vazobral® in patients with stage I-II discirculatory encephalopathy due to venous discirculation in the presence of chronic cerebrospinal venous insufficiency.Material and methods: 102 outpatients (average age 63.5 ± 3.74 years, 25 (25.5%) men and 77 (74.5%) women) suffering from chronic cerebral ischemia and having signs of chronic cerebrospinal venous insufficiency . Stage I dyscirculatory encephalopathy with mild cognitive impairment was diagnosed in 58 (59.2%) patients, stage II dyscirculatory encephalopathy with mild cognitive impairment was diagnosed. All observed had a duplex scan of the branches of the aortic arch, jugular and vertebral veins, with a measurement of the linear velocity of blood flow; the intensity of headaches, cognitive status, the severity of affective syndrome using special questionnaires were evaluated. For 3 months, patients took Vazobral® 8/80 mg per day. The data obtained were analyzed using computer programs SPSS and Statistica. Significance of differences – with a 95% CI, p

Despite the inadequate evidence of effi cacy and safety of opioid use for the treatment of migraine, it has been reported that patients with moderate to severe migraine headaches are prescribed opioids. Migraineurs may experience serious health impacts from opioids such as headache-related disability, psychiatric and cardiovascular comorbidities. The reduction of the risk of opioid abuse and prevention of an opioid epidemic are important public health challenges. The aim of this study was to assess the awareness of opioid therapy for migraine and the frequency of use among Turkish patients with episodic and chronic migraine. Materials and methods: consecutive migraine patients were enrolled in this cross-sectional study. A semi-structured questionnaire was developed and used by the researchers to assess the patients’ awareness of an opiod treatment option and the frequency of use of opioids for migraine treatment. Results. One hundred two patients were enrolled, of which 72 had episodic migraine and 30 had chronic migraine. All subjects reported that they had not been offered or prescribed any kind of opioids by general practitioners and neurologists for their headache. Besides, only 7 % of patients declared that they had heard of opioid treatment for migraine but they had never consulted their doctors about its effects. Conclusions. Our fi ndings demonstrated that opioids were not preferred as an option for acute or preventive migraine treatment by Turkish migraineurs and their physicians. The reduction of opioid prescription will help to prevent the development of medication overuse and opiate-induced headaches and drug addiction.

Aim. To evaluate the presence and the severity of the complaints (headache, dizziness, memory loss, concentration of attention, sleep disturbances, decreased mood, increased anxiety), the state of cognitive functions, emotional status and quality of night sleep in treatment-naïve middle-aged patients with mild to moderate EAH compared to healthy volunteers of the same age. Materials and methods. 103 treatment-naïve patients with EAH aged 40-59 years at the enrollment, who met the inclusion/exclusion criteria and provided written informed consent (46 men, mean age 53.6±0.8 years) and 50 healthy volunteers (17 men, mean age 51.5±1.0 years) with normal blood pressure (BP) level - control group - were enrolled to the study. Mean EAH duration was 2.9±5.7 years. Cognitive assessment included Montreal cognitive assessment, 10-words learning task, verbal fluency test, TMT, Stroop color and word test. Anxiety and depression were evaluated via Hamilton rating scales (HARS and HDRS). 24-hours ambulatory BP monitoring (ABPM) was performed according to European guidelines. Results. 70% of patients with EAH complained of memory disturbance, 68% - lack of attention, 22% - sleep disturbances, 12% - dizziness, 9% - headache. It took statistically significant more time for patients with EAH to perform on TMT B (p

Introduction: Cavernous hemangioma is a bening blood vessel malformation that can be located in the central nervous system. Although most patients who are found to have a CNS hemangioma are asymptomatic, the entity can cause a wide spectrum of symptoms including severe ones like epileptic seizures, stroke, diplopia, dysfasia or cognitive functions’ disorders. Case report: A 21-year-old female patient was admitted to the Department Of Neurology due to transient vision impairment, dysfasia, headache and tinnitus. Physical examination revealed no focal neurological signs. A brain MRI was performed. A cavernous hemangioma of 7-8 mm in size was found. The patient was examined by neurosurgeon as well, who did not qualify her for an immediate surgery. Discussion: Although cavernous hemangiomas are often asymptomatic, sometimes they can be a causative factor of different neurological symptoms. One should always take into account a possibility of cerebral hemangioma presence in young patients that suffer from headaches, tinnitis or have impaired vision.

The airplane headache is an incident of severe, clinically stereotypical pain during ascent or descent of an airplane. The entity is considered rare; however, growing numer of passengers in air transport results in better recognition of the problem. The airplane headache typically lasts less than 30 minutes and is unilateral, most often in fronto-orbital region and is connected with take-off or (more often) landing of the aircraft. The most important causative factor is sinus barotrauma attributed to changes in air pressure in passenger airliners during different phases of flight. So far there are only single cases or case series described in the literature. However, the problem can affect even a few percent of airline passengers. The condition is rare among children. The most effective treatment are triptans, but naproxen, paracetamol and nasal decongestants may play an important role either. There is an urgent need to conduct more researches on epidemology, pathogenesis and treatment of the headache attributed to airplane travel.

Melatonin is an endogenous chronobiotic that demonstrated its analgesic potential in an array of experimental and clinical studies. It proved efficient in fibromyalgia, irritable bowel syndrome, back pain and various types of headache. The level of evidence supporting melatonin’s analgesic properties in treating migraine and cluster headache is the highest. This review provides a summary of main papers currently available about the use of melatonin in the treatment of primary headache disorders of various types. It discusses possible mechanisms of melatonin analgesic action and prospects of its use in combination therapy of headache.

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Transcranial magnetic stimulation (TMS) is a rapidly developing method of neuromodulation. The use of TMS has increased significantly in both research and clinical practice. This allows not only to better understand this method, but also assess possible risks and consequences for both healthy individuals and patients. In 1998 and 2009 safety, ethical considerations, and application guidelines for the use of TMS in clinical practice and research were published. These recommendations are now the basis for safe application of the method in clinical practice and research. Safety of brain stimulation includes several aspects: the prevention and treatment of adverse effects, the strategy of patient and stimulation protocols selection, as well as safety and monitoring procedures. The most common adverse effects of TMS include headache and neck pain, syncope, transient hearing impairment. The risk of epileptic seizureis extremely low and can be minimized by careful selection of patients and the use of safe stimulation protocols. Careful selection of patients is important, taking into account a large number of factors that influence the risk of adverse effects. These factors are considered in the questionnaires to identify limitations and absolute or relative contraindications to TMS. Another important part of TMS safety is the choice of the stimulation protocol and parameters such as intensity, frequency, duration of one train of stimuli, and the interstimulus interval. Currently, the recommended limits of stimulation parameters are covered in the safety guidelines. It is also necessary to follow the procedure, including the monitoring the patient's condition during TMS and the providing qualified assistance in case of adverse effects.

The article reviews foreign and Russian literature on the organization of headache (HA) treatment. The economic burden of HA has been convincingly proven. The medical aid appealability of patients with HA has been established to be low (20–60%). This is frequently due to a lack of confidence in the success of a doctor's advice. The paper considers various models for the management of patients with HA in foreign countries. There is a low reliability of the diagnosis established during questionnaire surveys. Whether the patients can be managed using telecommunications, such as telephone and online counseling, is described. In Russia, there are substantially fewer treatment options for patients with HA; at the same time the available models are inclined to foreign ones. The paper describes world and Russian practices in educating the physicians and underlines the need for patients with HA to have educational classes. The sites where both the doctor and the patient can receive relevant information about HA are considered.

The article provides an experience of use of the new antidepressant with the precognitive action – Vortioxetine. High therapy compliance was demonstrated. The drug is effective in relief of depression, improves cognitive functions in neurologic patients and presumably has pain-killing action.

Background. Headache chronification is associated with significant negative impact on health-related quality of life (QOL). Patients with chronic migraine have decreased QOL and increased headache-related disability, than do patients with episodic migraine. The degree to which these outcomes are connected to disease severity, to the pattern of sociodemographic and comorbidity profiles, such as depression, anxiety and sleep disturbances, are unclear.Objective. To assess QOL and to identify predictors of its reduction in patients with chronic migraine.Materials and methods. 160 outpatients with migraine were recruited from a headache center and completed self-report questionnaires including the Headache Impact Test 6 (HIT-6) to assess QOL, Migraine Disability Assessment (MIDAS), Beck depression inventory, Spilberger–Khanin anxiety questionnaire, and Subjective sleep characteristics assessment questionnaire (SSCA). We used multiple regression analyses to obtain QОL predictors and path analysis model to identify relationship between the variables.Results. Patients with chronic migraine (n = 90) had very poor QOL, more severe migraine and comorbid disorders, than did patients with episodic migraine (n = 70). The strongest predictor of the QOL score was the Beck depression inventory score (β = 0.383; p < 0.001) and SSCA questionnaire score (β = –0.341; p < 0.001); followed by the MIDAS score (β = 0.301; p < 0.001), female gender (β = 0.198; p < 0.001), headache intensity (β = 0.173; p < 0.001), attack duration (β = 0.169; p = 0.001), headache frequency (β = 0.150; p = 0.015). Scores of Beck depression inventory, SSCA questionnaire, MIDAS, and headache features (frequency, duration, intensity) had a direct effect on the QOL. Conclusions. Depression and sleep disturbance appear to impair QOL as strong as the severe clinical manifestations of migraine.

The article prepared by a group of authors on the initiative of theRussian Headache Research Society (RHRS) is a result of theanalysis of approaches to the diagnosis of headache used by neurologistsand general practitioners in Russia and some post-Soviet countries. Common diagnostic mistakes and misinterpretationof instrumental investigations results, as well as the reasonsfor erroneous treatment strategies in patients with headacheare discussed. Practical steps focused on the improvement ofheadache diagnosis and treatment,as well as specialized care forheadache patients are proposed.