Somatic amplification and addiction profile as risk factors for medication overuse headache with chronic migraine.

INTRODUCTION: Overuse of analgesics can lead to medication-overuse headache (MOH) in chronic migraine (CM) patients, and is often linked to addiction. This study explores the addiction-related characteristics and somatic amplification in patients with, CM with medication overuse headache (CM+MOH), CM, and healthy controls. METHODS: 73 CM patients and 70 CM+MOH, along with 63 healthy controls, participated in the study. Assessments included a Sociodemographic Form, Migraine Disability Assessment Scale (MIDAS), Addiction Profile Index (API), Addiction Profile Index-Clinical Version (API-C), and the Somatosensory Amplification Scale (SSAS). RESULTS: Substance use characteristics, craving, motivation for use, and addiction severity scores were higher in the CM+MOH group than in both the CM and the control group. Specifically, the SSAS scores within the CM+MOH group surpassed those of both the CM and control groups. In the CM+MOH group, SSAS scores were a strong predictor of the amount of analgesic usage. Besides, craving and motivation for substance use scores significantly predicted the number of days analgesic taken per month in the CM+MOH group CONCLUSION: CM patients with MOH exhibit a pronounced association with addiction, and a heightened manifestation of somatic symptoms. Addressing addiction characteristics and psychosomatic amplification is important to ensure comprehensive management.

YouTube as a source of recognizing acute stroke; progress in 2 years.

BACKGROUND: YouTube™ has a great role in providing information, which includes educational videos, to more than 2 billion users, making it the second most popular application in the world. BE-FAST is a modified version of the FAST mnemonic and is used to detect acute ischemic stroke by the patients or their relatives. The purpose of this study is to assess the overall usefulness of the information of YouTube in patients to realize an acute stroke attack. METHODS: YouTube was searched for the following five terms: "stroke", ''stroke diagnosis", "stroke signs", "brain attack" and "what is stroke" in November 2021 and May 2023, separately. Two independent neurology specialists scored each video by using Global Quality Scale (GQS). RESULTS: Among the total of 150 videos, the number that met inclusion criteria was 91 for the November 2021 search and 104 for the May 2023 search. For the 2021 search, in 30 videos (33%), the FAST mnemonic or its contents were noticed, whereas BE-FAST was mentioned in only four videos (4.4%). For the 2023 search, the FAST mnemonic or its contents were noticed in 36 videos (34.6%) and BE-FAST was mentioned in 11 videos (10.6%). Among the 2021 and 2023 searches, the mean GQS values were 3.09 and 2.96 points, 50 (54.8%) vs. 56 (53.8%) videos rated 3.5 points or higher (high quality), respectively. GQS scores of the videos mentioning balance, eyes, face, arms, speech, and time, the basic and advanced information about radiology and treatment, and mentioning FAST, BE-FAST, and TPA were significantly higher. CONCLUSION: We conclude that YouTube is not yet a very useful tool for patients to realize that they may have acute ischemic stroke, though over the years; information available on social media for healthcare information and education has improved.

The role of metacognition, negative automatic thoughts and emotions in migraine-related disability among adult migraine patients.

This cross-sectional study investigates the relationship between problematic metacognitions, negative cognitive content and emotional distress, and migraine-related disability among adult migraine patients. The migraine group consisted of 74 patients. Forty-seven healthy volunteers with similar sociodemographic characteristics were selected as the comparison group. Sociodemographic form, Migraine Disability Assessment Scale, Depression Anxiety Stress Scale, Automatic Thought Questionnaire, and Metacognition Questionnaire-30 were administered. Our results showed that higher depression, anxiety, stress levels, and negative automatic thoughts are significantly associated with more significant migraine disability. Our data also showed that high levels of depression and increased headache frequency predict migraine-related severe disability. We found that the frequency of headaches over three months and positive beliefs about worry significantly predicted the presence of chronicity in migraine. Our findings may help determine different approaches such as cognitive behavioral therapy and relaxation techniques in treating migraine.

The effects of 30 Hz, 50 Hz AND 100 Hz continuous theta burst stimulation via transcranial magnetic stimulation on the electrophysiological parameters in healthy individuals.

BACKGROUND AND PURPOSE: Transcranial magnetic stimulation is a non-invasive procedure that uses robust magnetic fields to create an electrical current in the cerebral cortex. Dual stimulation consists of administering subthre-shold conditioning stimulation (CS), then suprathreshold test stimulation (TS). When the interstimulus interval (ISI) is 1-6 msec, the motor evoked potential (MEP) decreases in amplitude; this decrease is termed "short interval intracortical inhibition" (SICI); when the ISI is 7-30 msec, an increase in MEP amplitude occurs, termed "short interval intracortical facilitation" (SICF). Continuous theta burst stimulation (cTBS), often applied at a frequency of 50 Hz, has been shown to decrease cortical excitability. The primary objective is to determine which duration of cTBS achieves better inhibition or excitation. The secondary objective is to compare 50 Hz cTBS to 30 Hz and 100 Hz cTBS. METHODS: The resting motor threshold (rMT), MEP, SICI, and SICF were studied in 30 healthy volunteers. CS and TS were administered at 80%-120% and 70%-140% of rMT at 2 and 3-millisecond (msec) intervals for SICI, and 10- and 12-msec intervals for SICF. Ten individuals in each group received 30, 50, or 100 Hz, followed by administration of rMT, MT-MEP, SICI, SICF immediately and at 30 minutes. RESULTS: Greater inhibition was achieved with 3 msec than 2 msec in SICI, whereas better facilitation occurred at 12 msec than 10 msec in SICF. At 30 Hz, cTBS augmented inhibition and suppressed facilitation, while 50 Hz yielded less inhibition and greater inter-individual variability. At 100 Hz, cTBS provided slight facilitation in MEP amplitudes with less interindividual variability. SICI and SICF did not differ significantly between 50 Hz and 100 Hz cTBS. CONCLUSION: Our results suggest that performing SICI and SICF for 3 and 12 msec, respectively, and CS and TS at 80%-120% of rMT, demonstrate safer inhibition and facilitation. Recently, TBS has been used in the treatment of various neurological diseases, and we recommend preferentially 30 Hz over 50 Hz cTBS for better inhibition with greater safety and less inter-individual variability.

A rare aetiology of stroke; myxomatous aneurysm caused by atrial myxoma.

Atrial myxoma is a rare cause of stroke. In this report we present the case of a 52-year-old female patient who went to hospital suffering from a headache. Her neurological examination was normal except for a positive Babinski sign on the left. In the superolateral of the right, a Sylvian fissure consistent with a thrombosed aneurysm was detected using computerised tomography (CT). Diffusion MRI showed an acute infarction on the right MCA area. Transthorasic Echocardiography and ECG were normal. A -16×4 mm-sized fusiform perpendicular aneurysm on the M2 segment Sylvian curve of right MCA and a -6×4 mm-sized dissecting aneurysm on P3 segment of the left posterior cerebral artery (PCA) were observed in cerebral angiography. Transesophageal echocardiography (TEE) demonsrated a large mass with a suspected size of 2×2×1.5 cm on the left atrium. The mass was resected and on the eighth day after the operation, she had a temporary vision loss and hyperintensity on the T1 sequence was interpreted as laminary necrosis suspected on Cranial MRI. In follow up, she was stable with 300mg acetylsalicylic acid treatment. The main treatment is surgical resection in stroke caused by atrial myxoma.

Melatonin Related Acneiform Lesions: A Case Report and Potential Mechanism.

Melatonin (MLT) is a hormone secreted by the pineal gland according to the circadian rhythm, which is generated by the suprachiasmatic nucleus. The sleep-promoting effect of exogenous MLT is used to treat sleep disorders. The most common side effects reported are headache, somnolence, palpitations, and abdominal pain. Some studies showed dermatological side effects with the use of exogenous MLT, but did not list the specific symptoms. In this article, we describe a case of facial acne occurring after the use of MLT, which is generally known to have protective and healing effects on the skin, and the potential mechanism of this surprising side effect.

Comparing Colored and White-Black Visual Evoked Potentials in Multiple Sclerosis Patients.

INTRODUCTION: We compared white-black (WB), white-red (WR), and black-red (BR) checkerboard stimulated visual evoked potentials (VEPs) in multiple sclerosis (MS) patients and aimed to evaluate if redcolored VEP is more sensitive than WB VEP for the diagnosis of optic neuritis (ON). METHODS: Twenty-nine MS patients (21 females [72.4%]) and 35 healthy control subjects (24 females [68.6%]) were included in the study. Neurological and ophthalmological examinations were conducted for all subjects and VEP and optical coherence tomography (OCT) investigations were performed. RESULTS: A significant difference was found between MS patients and the control group for WB, WR, BR stimulated VEP P100 latencies and retinal nerve fiber length (RNFL) and ganglion cell complex (GCC) thicknesses, but there was no difference for WB, WR, and rb stimulated VEP amplitude values between the groups. There was no significant pathological difference between the eyes with an ON history in MS and eyes without an ON history in MS and control subjects after WB, WR, and BR stimulation (p=). CONCLUSIONS: The WB checkerboard stimulated VEP is an ample test for routine use; further studies are necessary regarding the utility of rb stimulated VEP in detecting subclinical ON.

Determination of Anxiety, Health Anxiety and Somatosensory Amplification Levels in Individuals with Benign Paroxysmal Positional Vertigo.

OBJECTIVES: Psychiatric comorbidities may intensify peripheral vertigo and increase the number of repositioning maneuvers required. This study was designed to examine the relationship between benign paroxysmal positional vertigo (BPPV) and anxiety and assess its association with somatic amplification and health anxiety. MATERIALS AND METHODS: Sixty patients with BPPV (43 women, 17 men; age range: 24-81 years, mean age 40.4±13.3), and 60 healthy participants (29 women, 31 men; age range: 18-71, mean age 38.2±11.43) were prospectively enrolled. The participants completed the Beck Anxiety Inventory (BAI), Short Health Anxiety Inventory (SHAI), and Somatosensory Amplification Scale (SSAS) questionnaires. RESULTS: The BAI scores of the patients with BPPV were higher than those of the control group participants and were as follows: (16.4 vs. 12.7; p=0.01). The SHAI (p=0.44) and SSAS (p=0.60) scores were not significantly different between the two groups. The BAI scores were positively correlated with the SHAI (rho: 0.273, p=0.035) and SSAS (rho: 0.357, p=0.005) scores. Neither the number of BPPV attacks nor the number of Epley maneuvers required showed any correlation with the BAI [(rho: 0.208, p=0.11); (rho: -0.007, p=0.96)], SHAI [(rho: 0.068, p=0.06); (rho: 0.021, p=0.87)], and SSAS [(rho: -0.081, p=0.53); (rho: -0.012, p=0.92)] scores. CONCLUSION: Our findings indicate that patients with BPPV had higher anxiety scores than healthy participants. Although our findings indicated normal health anxiety and somatic amplification levels in patients with BPPV, regular evaluation of psychological status would be a good strategy to prevent chronic dizziness.