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ObjectiveTo explore the experiences of patients suffering from new daily persistent headache (NDPH) regarding the diagnostic process, treatment and medical care.DesignA qualitative phenomenological study was conducted.SettingA specialised headache unit at two university hospitals in Spain between February 2017 and December 2018.ParticipantsPatients diagnosed with NDPH according to the International Classification of Headache disorders (third beta edition).MethodsPurposeful sampling was performed. Data were collected using unstructured and semistructured interviews, researchers’ field notes and patients’ drawings. An inductive thematic analysis was used to identify significant emerging themes from interviews, field notes and descriptions of patients’ drawings. Also, Guillemin’s proposal was used to analyse the contents of drawings.ResultsNineteen patients with a mean age of 45.3 were recruited. Four main themes emerged: (1) Seeking a diagnosis, patients visit many doctors without receiving a clear answer and their diagnosis is delayed; (2) Self-medication—minimising pill intake, medication is ineffective, and therefore, some patients discontinue treatment, or are flexible with how they take medication; (3) Trying other non-pharmacological options, many patients turn to other therapies and complementary and/or alternative therapies as a second option, however these are ineffective and (4) Medical care, with two subthemes, referrals and lacking continuity of care, and building the doctor–patient relationship. Patients describe how the referral breaks the continuity of care, and how they identify the traits of a doctor who is approachable and which behaviours the doctor should avoid when caring for patients.ConclusionsAn in-depth knowledge of the beliefs and expectations of patients with NDPH will allow the professional to establish a relationship of trust, which will improve the patients’ knowledge of which therapies are the most appropriate, and to establish expectations based on the relationship with the doctor, and not only on patients’ beliefs.

Resumen Las infecciones odontofaringeas pueden llevar a una obstruccion grave de la via aerea superior. La instrumentacion de la via aerea en dicha situacion clinica es un momento critico donde se pueden producir complicaciones que afecten a la permeabilidad de la via aerea, por lo que es necesario una adecuada valoracion teniendo en cuenta no solo los predictores de via aerea dificil clasicos, sino tambien las pruebas radiologicas. La disponibilidad actual de pruebas de imagen como la tomografia computarizada ha permitido una valoracion mas precisa de la localizacion del absceso odontofaringeo, asi como su relacion con la via aerea, permitiendo de esta manera planear un abordaje seguro de la misma. Presentamos 2 casos donde las imagenes radiologicas influyeron de forma determinante en el manejo de la via aerea y en la morbilidad de los pacientes.

Objectives This study aimed to explore the views and experiences of a group of Spanish patients suffering from new daily persistent headache (NDPH). Methods A qualitative descriptive study was conducted with patients diagnosed with NDPH. Purposeful sampling was performed among patients attending a specialized Headache Unit at 2 university hospitals between February 2017 and December 2018. In total, 18 patients (11 women, 7 men; mean age 45.3, standard deviation 10.6) with a median duration of illness of 70 months (interquartile range, 24-219) were recruited to this study. Data were collected through in-depth interviews, researchers' field notes and patients' drawings. Thematic analysis was used to identify emerging themes. Results Three main themes were identified: (1) the origin of the illness and seeking answers; (2) characteristics of the pain; and (3) the impact of pain on patients' lives. The patients precisely recalled the time of onset and the trigger of the pain. Pain was constantly present, although it varied in form. At the onset, pain was perceived as a sign of alarm while, over time, it became an invisible illness. The headache commonly had a major impact on everyday life and could cause lifestyle changes. In addition, pain could be emotionally disruptive and could also lead to family estrangement and a search for solitude. Conclusions Our results provide insight into how NDPH is experienced, which may be helpful in managing NDPH patients. In our cohort, patients identified precipitating events but sought answers regarding the origin of their illness and their pain. Pain was a continuous sensation that had a major impact on patients' daily lives and emotions.

Increase in body temperature is associated with neurological deficit exacerbations in patients with multiple sclerosis (MS). These are corrected with the resolution of hyperthermia, in what is known as Uhthoff's phenomenon. A 65-year-old patient with primary progressive MS, admitted because of hip fracture, developed acute respiratory failure in association with elevation in body temperature (38 °C) due to an increase in room temperature. Additional tests ruled out infection, pulmonary thromboembolism, or other concomitant processes. The patient's respiratory condition improved following a change in room temperature and the use of pharmacological treatment for hyperthermia. She was taken to surgery under general anesthesia 3 days after admission, with tight temperature monitoring, and surgery proceeded uneventfully. Anesthetic management in patients with MS is important, requiring close control of body temperature to avoid comorbidities and perioperative complications.