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Introduction Chronic periodontitis and atherosclerosis share common risk factors and produce the same inflammatory markers. Many studies found a high prevalence of chronic periodontitis in patients with atherosclerosis but there is no strong evidence to support a specific association of chronic periodontitis with cerebral atherosclerosis. We aimed to study the concurrent prevalence and association of chronic periodontitis with cerebral atherosclerosis and cerebrovascular diseases among the US population. Methods We performed a cross-sectional analysis of a Nationwide Inpatient Sample with adult hospitalizations to identify the primary diagnosis of cerebrovascular diseases [acute ischemic stroke (AIS), hemorrhagic stroke (HS), and transient ischemic attack (TIA)] with concurrent cerebral atherosclerosis and chronic periodontitis. Multivariate survey logistic regression models were fitted to evaluate the linkage of chronic periodontitis with cerebral atherosclerosis and cerebrovascular diseases. Results Of total 56,499,788 hospitalizations, 0.01% had chronic periodontitis. Prevalence of chronic periodontitis was higher in 50-64 years (36.18% vs. 23.91%), males (59.19% vs. 41.06% in females), Afro-Americans (25.93% vs. 15.21%), and 0-25th percentile median-household-income-category (38.31% vs. 30.15%) compared to non-chronic periodontitis. There was significantly higher prevalence of cerebral atherosclerosis (0.71% vs. 0.41%; p<0.0001) with weak evidence of high prevalence of cerebrovascular diseases (AIS:2.21% vs. 1.97%; p=0.1563; HS:0.57% vs. 0.46%; p=0.1560) among chronic periodontitis compared to non-chronic periodontitis. In regression analysis, odds of having cerebral atherosclerosis were 2.48-folds higher in patients with chronic periodontitis compared to that without-chronic periodontitis, and cerebral atherosclerosis patients were associated with higher odds of TIA (aOR:2.40; p<0.0001), AIS (aOR:3.35; p<0.0001), and HS (aOR:1.51; p<0.0001) compared to without-cerebral atherosclerosis. No significant relationship between chronic periodontitis and cerebrovascular diseases was observed. Conclusion Although chronic periodontitis may not directly increase the risk of cerebrovascular diseases, it increases the burden of cerebrovascular diseases by evidently increasing the risk of cerebral atherosclerosis. Early identification of chronic periodontitis and atherosclerotic risk factors may help to mitigate the risk of cerebrovascular diseases.
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Introduction The opioid epidemic has been linked to several other health problems, but its impact on headache disorders has not been well studied. We performed a population-based study looking at the prevalence of opioid use in headache disorders and its impact on outcomes compared to non-abusers with headaches. Methodology We performed a cross-sectional analysis of the Nationwide Inpatient Sample (years 2008-2014) in adults hospitalized for primary headache disorders (migraine, tension-type headache [TTH], and cluster headache [CH]) using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. We performed weighted analyses using the chi-square test, Student's t-test, and Cochran-Armitage trend test. Multivariate survey logistic regression analysis with weighted algorithm modelling was performed to evaluate morbidity, disability, and discharge disposition. Among US hospitalizations during 2013-2014, regression analysis was performed to evaluate the odds of having opioid abuse among headache disorders. Results A total of 5,627,936 headache hospitalizations were present between 2008 and 2014 of which 3,098,542 (55.06%), 113,332 (2.01%), 26,572 (0.47%) were related to migraine, TTH, and CH, respectively. Of these headache hospitalizations, 128,383 (2.28%) patients had abused opioids. There was a significant increase in the prevalence trend of opioid abuse among patients with headache disorders from 2008 to 2014. The prevalence of migraine (63.54% vs. 54.86%), TTH (2.29% vs. 2.01%), and CH (0.59% vs. 0.47%) was also higher among opioid abusers than non-abusers (p<0.0001). Opioid abusers with headaches were more likely to be younger (43 years old vs. 50 years old), men (30.17% vs. 24.78%), white (80.83% vs. 73.29%), Medicaid recipients (30.15% vs. 17.03%), and emergency admissions (85.4% vs. 78.51%) as compared to opioid non-abusers with headaches (p<0.0001). Opioid abusers with headaches had higher prevalence and odds of morbidity (4.06% vs. 3.70%; adjusted odds ratio [aOR]: 1.48; 95% CI: 1.39-1.59), severe disability (28.14% vs. 22.43%; aOR: 1.58; 95% CI: 1.53-1.63), and discharge to non-home location (17.13% vs. 18.41%; aOR: 1.35; 95% CI: 1.30-1.40) as compared to non-abusers. US hospitalizations in years 2013-2014 showed the migraine (OR: 1.61; 95% CI: 1.57-1.66), TTH (OR: 1.43; 95% CI: 1.22-1.66), and CH (OR: 1.34; 95% CI: 1.01-1.78) were linked with opioid abuse. Conclusion Through this study, we found that the prevalence of migraine, TTH, and CH was higher in opioid abusers than non-abusers. Opioid abusers with primary headache disorders had higher odds of morbidity, severe disability, and discharge to non-home location as compared to non-abusers.
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BACKGROUND/OBJECTIVE: Nummular headache (NH) is a primary headache disorder characterised by intermittent or continuous scalp pain, affecting a small circumscribed area of the scalp. As there are limited data in the literature on NH, we conducted this review to evaluate demographic characteristics and factors associated with complete resolution of the headache, and effectiveness of treatment options. METHODS: We performed a systematic review of cases reported through PubMed database, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol and 'nummular headache', 'coin-shaped headache' and 'coin-shaped cephalalgia' keywords. Analysis was performed by using χ2 test and Wilcoxon rank-sum test. For individual interventions, the response rate (RR%) of the treatment was calculated. RESULTS: We analysed a total of 110 NH cases, with median age 47 years and age of pain onset 42 years. Median duration to make correct diagnosis was 18 months after first attack. The median intensity of each attack was 5/10 on verbal rating scale over 4 cm diameter with duration of attack <30 min. Patients with NH had median three attacks per day with frequency of 9.5 days per month. 40 (57.97%) patients had complete resolution of the headache after treatment. Patients with complete resolution were younger, more likely to be female, and were more likely to have diagnosis within year. Patients with complete resolution more likely to have received treatment with onabotulinum toxin A (botulinum toxin type A (BoNT-A)), and gabapentin compared with patients without complete resolution. Most effective interventions were gabapentin (n=34; RR=67.7%), non-steroidal anti-inflammatory drugs (NSAIDs) (n=32; RR=65.6%), BoNT-A (n=12; RR=100%) and tricyclic antidepressant (n=9; RR=44.4%). CONCLUSION: Younger patients, female sex and early diagnosis were associated with complete resolution. NSAIDs, gabapentin and BoNT-A were most commonly used medications, with significant RRs.
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INTRODUCTION: Migraine is a chronic disabling neurological disease, with an estimated expense of $15-20 million/year. Several studies with a small number of patients have studied risk factors for migraine such as cardiovascular disorders, stroke, smoking, demographic, and genetic factors but this is the first comprehensive study for evaluation of vascular and nonvascular risk factors. It is important to evaluate all the risk factors that help to prevent the healthcare burden related to migraine. Methodology: We performed a retrospective cross-sectional analysis of the Nationwide Inpatient Sample (NIS) (years 2013-2014) in adult (>18-years old) hospitalizations in the United States. Migraine patients were identified using ICD-9-CM code to determine the demographic characteristics, vascular, and nonvascular risk factors. Univariate analysis was performed using the chi-square test and a multivariate survey logistic regression analysis was performed to identify the prevalence of the risk factors and evaluate the odds of prevalence of risk factors amongst migraine patients compared to nonmigraine patients, respectively. RESULTS: On weighted analysis, after removing missing data of age, gender and race, from years 2013 to 2014, of the total 983,065 (1.74%) migraine patients were identified. We found that younger (median age 48-years vs. 60-years), female (82.1% vs. 58.5%; p<0.0001), white population (76.8% vs. 70.5%; p<0.0001), and privately insured (41.1% vs. 27.4%; p<0.0001) patients were more likely to have migraine than others. Cerebral atherosclerosis, diabetes mellitus, ischemic heart disease, atrial fibrillation, and alcohol abuse were not significantly associated with migraine. Migraineurs had higher odds of having hypertension [odds ratio (OR): 1.44; 95% confidence interval (CI): 1.43-1.46; 44.49% vs. 52.84%], recent transient ischemic attack (TIA) (OR: 3.13; 95%CI: 3.02-3.25; 1.74% vs. 0.67%), ischemic stroke (OR: 1.40; 95%CI: 1.35-1.45; 2.06% vs. 1.97%), hemorrhagic stroke (OR: 1.11; 95%CI: 1.04-1.19; 0.49% vs. 0.46%), obesity (OR: 1.46; 95%CI: 1.44-1.48; 19.20% vs. 13.56%), hypercholesterolemia (OR: 1.33; 95%CI: 1.30-1.36; 5.75% vs. 5.54%), substance abuse (OR: 1.51; 95%CI: 1.48-1.54; 7.88% vs. 4.88%), past or current consumption of tobacco (OR: 1.40; 95%CI: 1.38-1.41; 31.02% vs. 27.39%), AIDS (OR: 1.13; 95%CI: 1.04-1.24; 0.33% vs. 0.41%), hypocalcemia (OR: 1.09; 95%CI: 1.03-1.14; 0.77% vs. 0.89%), and vitamin D deficiency (OR: 1.93; 95%CI: 1.88-1.99; 2.47% vs. 1.37%) than patients without migraine. Female patients were at a higher risk of migraine (OR: 3.02; 95%CI: 2.98-3.05) than male. CONCLUSION: In this study, we have identified significant risk factors for migraine hospitalizations. Early identification of these risk factors may improve the risk stratification in migraine patients.