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Objective: The present study is aimed at determining the percentage of temporomandibular joint disorder (TMD) in patients admitted to the neurology outpatient clinic with a headache complaint and to evaluate the association of TMD with the presence of bruxism and headache traits., Materials and Methods: A total of 349 headache patients were included in the study. The headache type, characteristics of the headache (incidence, duration, and severity of attacks), and the scores of the migraine disability scale (MIDAS) and Allodynia Symptom Scale (ASC-12T) were examined considering the presence of sleep bruxism. The International Classification of Headache Disorders (ICHD-3 Beta) criteria were used for diagnosing headaches. The presence of TMD was evaluated by using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). All patients diagnosed with TMD and/or bruxism were evaluated by a dentist., Results: A total of 349 patients, 259 females and 90 males, were included in the study. The mean age of the patients was 36 years. Primary and secondary headaches were diagnosed in 317 (90.80%) and 32 (9.20%) patients, respectively. In the primary headache group, there were 227 migraines (182 females, 45 males), 74 tension-type headaches (TTH) (48 females, 26 males), and 15 trigeminal autonomic cephalalgias (TACs) (7 females, 8 males) patients. The remaining patients were diagnosed with other types of diagnoses. The rate of patients with chronic headache was 86.50%. TMD was detected in 89 (25.50%) of the patients while sleep bruxism was present in 80 (23.30%) patients. TMD was detected in 68 (30.0%) migraine patients and 13 (17.60%) TTH patients. The rate of TMD was statistically significantly higher in migraine patients compared to the TTH patients (p=0.037)., Conclusion: Our cross-sectional outpatient-based study determined the incidence of TMD in headache patients as 25%. Among the primary headaches, the incidence of TMD was higher in migraine patients compared to the other diagnoses. Considering these data, the presence of TMD is a clinical condition that should be considered in the pathophysiology of headache, primarily migraine, and especially in cases of non-response to treatment., (© 2021. Fondazione Società Italiana di Neurologia.)

Objectives: Headache is the most common complaint in cerebral venous sinus thrombosis (CVST) and it may sometimes be the only symptom in these patients. This retrospective and prospective study was an investigation of any differences in terms of clinical risk factors, radiological findings, or prognosis in patients with CVST who presented with isolated headache (IH) and cases with other concomitant findings (non-isolated headache [NIH])., Methods: A total of 1144 patients from a multicenter study of cerebral venous sinus thrombosis (VENOST study) were enrolled in this research. The demographic, biochemical, clinical, and radiological aspects of 287 IH cases and 857 NIH cases were compared., Results: There were twice as many women as men in the study group. In the IH group, when gender distribution was evaluated by age group, no statistically significant difference was found. The onset of headache was frequently subacute and chronic in the IH group, but an acute onset was more common in the NIH group. Other neurological findings were observed in 29% of the IH group during follow-up. A previous history of deep, cerebral, or other venous thromboembolism was less common in the IH group than in the NIH group. Transverse sinus involvement was greater in the IH group, whereas sagittal sinus involvement was greater in the NIH group. The presence of a plasminogen activator inhibitor (PAI) mutation was significantly greater in the IH group., Conclusion: IH and CVST should be kept in mind if a patient has subacute or chronic headache. PAI, which has an important role in thrombolytic events, may be a risk factor in CVST. Detailed hematological investigations should be considered. Additional studies are needed.

Introduction: Cerebral venous and sinus thrombosis (CVST) may lead to cerebral edema and increased intracranial pressure; besides, ischemic or hemorrhagic lesions may develop. Intracerebral hemorrhages occur in approximately one-third of CVST patients. We assessed and compared the findings of the cerebral hemorrhage (CH) group and the CVST group., Materials and Methods: In the VENOST study, medical records of 1,193 patients with CVST, aged over 18 years, were obtained from 35 national stroke centers. Demographic characteristics, clinical symptoms, signs at the admission, radiological findings, etiologic factors, acute and maintenance treatment, and outcome results were reported. The number of involved sinuses or veins, localizations of thrombus, and lesions on CT and MRI scans were recorded., Results: CH was detected in the brain imaging of 241 (21.1%) patients, as hemorrhagic infarction in 198 patients and intracerebral hemorrhage in 43 patients. Gynecologic causes comprised the largest percentage (41.7%) of etiology and risk factors in the CVST group. In the CH group, headache associated with other neurological symptoms was more frequent. These neurological symptoms were epileptic seizures (46.9%), nausea and/or vomiting (36.5%), altered consciousness (36.5%), and focal neurological deficits (33.6%). mRS was ≥3 in 23.1% of the patients in the CH group., Discussion and Conclusion: CVST, an important cause of stroke in the young, should be monitored closely if the patients have additional symptoms of headache, multiple sinus involvement, and CH. Older age and parenchymal lesion, either hemorrhagic infarction or intracerebral hemorrhage, imply poor outcome., (© 2020 S. Karger AG, Basel.)

Aim: Systemic lupus erythematosus (SLE) is an unusual risk factor for cerebral venous sinus thrombosis (CVST). As few CVST patients with SLE have been reported, little is known regarding its frequency as an underlying etiology, clinical characteristics, or long-term outcome. We evaluated a large cohort of CVST patients with SLE in a multicenter study of cerebral venous thrombosis, the VENOST study, and their clinical characteristics., Material and Method: Among the 1144 CVST patients in the VENOST cohort, patients diagnosed with SLE were studied. Their demographic and clinical characteristics, etiological risk factors, venous involvement status, and outcomes were recorded., Results: In total, 15 (1.31%) of 1144 CVST patients had SLE. The mean age of these patients was 39.9 ± 12.1 years and 13 (86.7%) were female. Presenting symptoms included headache (73.3%), visual field defects (40.0%), and altered consciousness (26.7%). The main sinuses involved were the transverse (60.0%), sagittal (40.0%), and sigmoid (20.0%) sinuses. Parenchymal involvement was not seen in 73.3% of the patients. On the modified Rankin scale, 92.9% of the patients scored 0-1 at the 1-month follow-up and 90.9% scored 0-1 at the 1-year follow-up., Conclusions: SLE was found in 1.31% of the CVST patients, most frequently in young women. Headache was the most common symptom and the CVST onset was chronic in the majority of cases. The patient outcomes were favorable. CVST should be suspected in SLE patients, even in those with isolated chronic headache symptoms with or without other neurological findings., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: Chronic migraine (CM) is a frequent complication of migraines that has a serious impact on personal and social life and is still underdiagnosed. The aim of this study was to determine risk factors for the progression to CM and to investigate the relationship of these factors to the disease prognosis., Methods: In all, 115 CM and 377 episodic migraine patients from between February 2015 and December 2017 were enrolled. The age of disease onset, headache duration and frequency, presence of aura and type of aura, clinical properties and location of headache, pain severity, trigger factors, presence of family history, visual analogue scale (VAS) and Allodynia Symptom Checklist (ASC) scores, presence of allodynia, and Migraine Disability Assessment (MIDAS) scores were recorded and the 2 groups were compared statistically. Logistic regression was used to determine the independent risk factors for a conversion to CM., Results: The mean age of the 492 patients (408 female, 84 male) was 36.03±12.67 years, the disease duration was 10.78±10.36 years, the attack frequency was 10.35±9.06 attacks/month, and the attack duration was 30.10±23.54 hours. There were 115 patients (104 female, 11 male) with CM. Female gender (p=0.015), attack frequency (p<0.001), ASC score (p=0.002), VAS score (p=0.001), and MIDAS score (p<0.001) had greater representation in the CM group. Medication overuse (relative risk [RR]: 0.9) and allodynia (RR: 0.3) were independent risk factors for a transition to CM in the logistic regression analysis (p<0.05)., Conclusion: Based on the present data of a tertiary headache center, it was concluded that CM is a disabling neurological disease with a serious personal and public burden. Special care should be taken among patients with medication overuse and cutaneous allodynia with regard to the possibility of transition to CM.

Objectives: There are only a handful of studies examining the clinical differences between patients with and without a family history of migraine. Our aim is to compare the descriptive and clinical properties of patients with and without a family history, and to investigate the association between the migraine burden and disease characteristics and disability of migraine., Methods: A total of 530 consecutive patients diagnosed with migraine according to the International Headache Society criteria were enrolled into the study. Detailed systemic and neurological examinations, and blood pressure, weight, height, and body mass index measurements, clinical and demographical data, the visual analog scale, allodynia symptom checklist, and the Migraine Disability Assessment Scale (MIDAS) scores were recorded. The groups with and without a family history of migraine were compared statistically., Results: Patients with a positive family history had a higher educational status (high school and higher) (p<0.05) and an increased triggering of pain with physical activity (p=0.013). The age at onset was earlier (p=0.049); disease duration was longer (p=0.030), and MIDAS scores were significantly higher (p=0.028) in patients with a family history of migraine., Conclusion: Having a family history of migraine is associated with an earlier age at onset and a longer disease duration, in addition to an increased disability in these patients. The family history may be assumed as a marker of the genetic load in migraineurs; therefore, an early diagnosis and an appropriate management are essential in these patients to avoid migraine-related disability.

Background: It is well known that axonal degeneration plays a role in disability in patients with multiple sclerosis, and synaptopathy has recently become an important issue., Aims: To investigate the possible roles of selected synaptic and presynaptic membrane protein genetic polymorphisms (VAMP2, SNAP-25, synaptotagmin, and syntaxin 1A) in patients with multiple sclerosis., Study Design: Case-control study., Methods: A total of 123 patients with multiple sclerosis and 192 healthy controls were included. The functional polymorphisms of specific SNARE complex proteins (VAMP2, synaptotagmin XI, syntaxin 1A, and SNAP-25) were analyzed by polymerase chain reaction., Results: Significant differences were detected in the genotype and allele distribution of 26-bp Ins/Del polymorphisms of VAMP2 between patients with multiple sclerosis and control subjects; Del/Del genotype and Del allele of VAMP2 were more frequent in patients with multiple sclerosis (p=0.011 and p=0.004, respectively). Similarly, Ddel polymorphism of SNAP-25 gene C/C genotype (p=0.059), syntaxin 1A T/C and C/C genotypes (p=0.005), and synaptotagmin XI gene C allele (p=0.001) were observed more frequently in patients with multiple sclerosis. CC, syntaxin rs1569061 1A gene for 33-bp promoter region TC haplotypes, and synaptotagmin XI gene were found to be associated with an increased risk for multiple sclerosis (p=0.012). Similarly, GC haplotype for rs3746544 of SNAP-25 gene and rs1051312 of SNAP-25 gene were associated with an increased risk for multiple sclerosis (p=0.022)., Conclusion: Genetic polymorphisms of SNARE complex proteins, which have critical roles in synaptic structure and communication, may play a role in the development of multiple sclerosis.

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a rare, primary headache syndrome, which is classified as a subtype of trigeminal autonomic cephalalgias. Although SUNCT is usually refractory to treatment, several antiepileptic drugs have recently shown promising results for its treatment. However, there is a lack of evidence regarding the course of SUNCT during pregnancy and the available treatment options. Here, we present a 30-week pregnant female with SUNCT who was successfully treated with infra- and supraorbital nerve blocks. Headache attacks completely diminished after the injection, and recurrence was not observed. Although lamotrigine may be relatively safe in pregnant patients with SUNCT attacks, peripheral nerve block may be a feasible technique and can be considered as a safe and effective treatment option. This is the first SUNCT case in the literature that was successfully treated with infra- and supraorbital nerve blocks during pregnancy.

Background: The 2013 International Classification of Headache Disorders-3 was published in a beta version to allow clinicians to confirm the validity of the criteria or suggest improvements based on field studies. The aim of this work was to review the Secondary Headache Disorders and Cranial Neuralgias and Other Headache Disorders sections of ICHD-3 beta data on children and adolescents (age 0-18 years) and to suggest changes, additions, and amendments., Methods: Several experts in childhood headache across the world applied different aspects of ICHD-3 beta in their normal clinical practice. Based on their personal experience and the available literature on pediatric headache, they made observations and proposed suggestions for the mentioned headache disorders on children and adolescents., Results: Some headache disorders in children have specific features, which are different from adults that should be acknowledged and considered. Some features in children were found to be age-dependent: clinical characteristics, risks factors and etiologies have a strong bio psychosocial basis in children and adolescents making primary headache disorders in children distinct from those in adults., Conclusions: Several recommendations are presented in order to make ICHD-3 more appropriate for use in children.

Background: The 2013 International Classification of Headache Disorders-3 (ICHD-3) was published in a beta version to allow the clinicians to confirm the validity of the criteria or to suggest improvements based on field studies. The aim of this work was to review the Primary Headache Disorders Section of ICHD-3 beta data on children and adolescents (age 0-18 years), and to suggest changes, additions, and amendments., Methods: Several experts in childhood headache across the world applied different aspects of ICHD-3 beta in their normal clinical practice. Based on their personal experience and the literature available on pediatric headache, they made observations and proposed suggestions for the primary headache disorders section of ICHD-3 beta data on children and adolescents., Results: Some headache disorders in children have specific features which are different from those seen in adults and which should be acknowledged and considered. Some features in children were found to be age-dependent: clinical characteristics, risks factors and etiologies have a strong bio psycho-social basis in children and adolescents making primary headache disorders in children distinct from those in adults., Conclusions: Several recommendations are presented in order to make ICHD-3 more appropriate for use with children.

Background: Chronic migraine is a disabling, under-recognized, and undertreated disorder that increases health burdens. The aim of this study was to evaluate phenotypic features and the relevance of accompanying symptoms of migraine attacks in chronic migraine., Method: This study was conducted as part of an ongoing Turkish Headache Database Study investigating the clinical characteristics and outcomes of headache syndromes in the Turkish population. The electronic database was examined retrospectively, and 835 patients with chronic migraine were included., Results: Patient group consisted of 710 women and 125 men (85 and 15 %, respectively). Mean patient age was 36.8 ± 13.5 years, median value of migraine onset was 60 months (18-120), median headache frequency was 25 days per month (16-30), median of attack duration was 12 h (4-24), and median of intensity was eight (7-9). Increasing headache days per month were inversely related with the presence of nausea, vomiting, phonophobia, and photophobia. Longer duration of headache (months) and higher visual analog scale (VAS) for headache intensity were associated with all accompanying symptoms. Phonophobia, nausea, photophobia, and vomiting were the most frequent accompanying symptoms (experienced by 80.2, 77.6, 71.2, and 40.9 % of patients, respectively). Osmophobia was also frequent in chronic migraine patients (53.4 %) and was closely associated with other accompanying symptoms. Vertigo and dizziness were observed less frequently, and they were not associated with accompanying symptoms., Conclusion: Phenotype of chronic migraine may be associated with the course of chronification. Duration of illness and attack intensity were closely related with the presence of accompanying symptoms, although headache frequency was found to be inversely related to the presence of accompanying symptoms. Osmophobia was also a frequent symptom and was closely related with other accompanied symptoms, unlike vertigo and dizziness. Inclusion of osmophobia into the diagnostic criteria might improve accurate diagnosis of chronic migraine.

Background: Excessive apoptosis is believed to play a role in many degenerative and non-degenerative neurological diseases including Alzheimer's disease (AD). Much recent data suggest that apoptotic mechanisms may represent the missing link between Aβ deposition and proteolysis of tau protein. However, there is emerging evidence that apoptotic mechanisms may play a role in Alzheimer's Disease pathogenesis in the absence of overt apoptosis. TNF-related apoptosis inducing ligand receptor 1 (Death Receptor 4, DR4) might impair the apoptotic signal transduction and lead to dysregulation of the homeostasis between cell survival and cell death., Aims: The aim of our study was to further investigate the relationship between genetic variants of DR4 and Alzheimer's Disease., Study Design: Case control study., Methods: Sixty-eight patients with AD were included in the study. The control group comprised 72 subjects without signs of neurodegenerative diseases, as evidenced by the examination.DNA was extracted from whole blood using the salting-out procedure. Genotypes were identified by restriction fragment length polymorphism analysis of polymerase chain reaction (PCR-RFLP) products., Results: We observed significant differences in the genotypic distribution of the rs6557634 polymorphism in AD patients compared with controls (p<0.05); our data suggest that the GA genotype in rs6557634 could be protective against AD (p<0.05). However, there were no significant differences between AD patients and control groups in terms of the DR4 rs20575 polymorphism (p>0.05) and the DR4 rs20576 polymorphism (p>0.05). According to haplotype analysis of the DR4 gene for rs6557634, rs20575 and rs20576 polymorphisms, GCA and GCC haplotypes might be a risk factor for AD. Also, we have shown that ACA, GGC and GGA haplotypes might be protective factors against AD., Conclusion: The present results indicate for the first time the possible contribution of the DR4 gene rs6557634, rs20575, rs20576 polymorphisms in Alzheimer's Disease, which may influence susceptibility to Alzheimer's Disease.