The burden of headache in China: validation of diagnostic questionnaire for a population-based survey.

The objective of this study was to test the validity, in the Chinese population, of the Lifting The Burden diagnostic questionnaire for the purpose of a population-based survey of the burden of headache in China. From all regions of China, a population-based sample of 417 respondents had completed the structured questionnaire in a door-to-door survey conducted by neurologists from local hospitals calling unannounced. They were contacted for re-interview by telephone by headache specialists who were unaware of the questionnaire diagnoses. A screening question ascertained whether headache had occurred in the last year. If they had, the specialists applied their expertise and ICHD-II diagnostic criteria to make independent diagnoses which, as the gold standard, were later compared with the questionnaire diagnoses. There were 18 refusals; 399 interviews were conducted in 202 women and 197 men aged 18-65 years (mean age 44.4±12.6 years). In comparison to the specialists' diagnoses, the sensitivity, specificity, positive predictive value, negative predictive value and Cohen's kappa (95% CI) of the questionnaire for the diagnosis of migraine were 0.83, 0.99, 0.83, 0.99 and 0.82 (0.71-0.93), respectively; for the diagnosis of tension-type headache (TTH), they were 0.51, 0.99, 0.86, 0.92 and 0.59 (0.46-0.72), respectively. In conclusion, the questionnaire was accurate and reliable in diagnosing migraine (agreement level excellent), less so, but adequate, for TTH (sensitivity relatively low, false negative rate relatively high and agreement level fair to good). The non-specific features of TTH do not lend themselves well to diagnosis by questionnaire.

[A meta-analysis of the correlation between obesity and migraine].

OBJECTIVE: To explore the relationship between obesity and migraine. METHODS: The online databases inlcuding PubMed, EMBASE, Wanfang, CNKI and Chinese Biological Medicine Database were searched for studies assessing the relationship between obesity and migraine according to the Cochrane Collaboration guidelines. Stata12.0 software was used for meta- analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the relationship between obesity and the risk of migraine. RESULT: A total of 14 studies involving 193 274 individuals were included in the analysis. The results of meta-analysis showed that obese individuals had an increased risk of migraine by 19% as compared with normal weight individuals [OR, 1.19; 95% CI, 1.02-1.38; P=0.029) and by 19% as compared with non-obese individuals (OR, 1.19; 95%CI, 1.02-1.38; P=0.024). CONCLUSION: Obesity is associated with an increased risk of migraine.

Autoimmune encephalitis mimicking sporadic Creutzfeldt-Jakob disease: A retrospective study.

Autoimmune encephalitis associated with anti-voltage-gated potassium channel antibodies are most likely to be misdiagnosed as sporadic Creutzfeldt-Jakob disease (sCJD). Our goal was to delineate patients who were initially suspected to have CJD but were later found to have AE. We performed a retrospective clinical review of cases of individuals and made a comparison between groups of patients diagnosed with sCJD and AE. Patients who had rapidly progressing dementia and focal neurological impairment, such as aphasia, gait disturbance, visual disturbance, and depression, at onset were diagnosed with sCJD, whereas epilepsy, hyponatremia and dysautonomia were strong hints for AE. Fluoroscope-positron emission tomography (PET) of patients with AE revealed variable metabolism and normative and long-term immunosuppression were less likely to relapse.

Evaluation of the efficacy and safety of vilazodone for treating major depressive disorder.

PURPOSE: Vilazodone is a novel serotonin (5-HT)-reuptake inhibitor and 5-HT1A partial agonist that was recently developed for the treatment of major depressive disorder (MDD). We conducted a meta-analysis and systematic review to better evaluate the efficacy and safety of vilazodone. MATERIALS AND METHODS: We performed a thorough literature search to identify all randomized double-blind placebo-controlled trials that were designed to investigate the efficacy of vilazodone for the treatment of MDD, and that were published in electronic databases, including Medline, Embase, and the Cochrane Central Register of Controlled Trials. A manual search was also conducted to investigate the relevant references of the retrieved studies. Subsequently, we conducted a meta-analysis and systematic literature review. RESULTS: A total of five randomized controlled trials were finally included, involving 1,200 patients with vilazodone and 1,193 patients with placebo. The primary efficacy end point of the Montgomery-Åsberg Depression Rating Scale (standardized mean difference -3.58, 95% confidence interval -4.59 to -2.56; P<0.00001), and the key secondary efficacy end points (Clinical Global Impression - Severity scale, Clinical Global Impression - Improvement scale, and Hamilton Anxiety Rating Scale) indicated that vilazodone was more effective than placebo. Most common adverse events, including diarrhea and nausea, were evaluated, and safety assessments indicated that vilazodone was well tolerated (diarrhea odds ratio 3.54, 95% confidence interval 2.81-4.45; P<0.00001; nausea odds ratio 3.85, 95% confidence interval 3.00-4.96; P<0.00001; discontinuations due to adverse events odds ratio 2.71, 95% confidence interval 1.81-4.05; P<0.00001). CONCLUSION: Our findings indicate that the novel antidepressant vilazodone is effective and safe for MDD, with a low occurrence of side effects. It offers promise as an effective oral drug for the treatment of MDD, with a balance of efficacy and tolerability.

Migraine-like headache and ischemic strokes in two patients with Lambl's excrescences.

Lambl's excrescences are filiform structures attached to the edges of cardiac valves and have been associated with stroke. Here we report two patients with Lambl's excrescences who developed migraine-like headaches followed by cerebral infarction. Their Lambl's excrescences were first identified by transesophageal echocardiography. One patient was given aspirin and another had surgery for debridement of excrescences. Their outcomes were good. The migraine-like headache might be the first symptom of cerebral ischemia and might be triggered by micro-emboli originated from Lambl's excrescences. Patients with Lambl's excrescences should be closely monitored and surgery should be considered in recurrent stroke cases.

Altered regional homogeneity in spontaneous cluster headache attacks: a resting-state functional magnetic resonance imaging study.

BACKGROUND: Functional neuroimaging study has opened an avenue for exploring the pathophysiology of cluster headache (CH). The aim of our study was to assess the changes in brain activity in CH patients by the regional homogeneity method using resting-state functional magnetic resonance imaging technique. METHODS: The functional magnetic resonance imaging scans were obtained for 12 male CH patients with spontaneous right-sided headache attacks during "in attack" and "out of attack" periods and 12 age- and sex-matched normal controls. The data were analyzed to detect the altered brain activity by the regional homogeneity method using statistical parametric mapping software. RESULTS: Altered regional homogeneity was detected in the anterior cingulate cortex, the posterior cingulate cortex, the prefrontal cortex, insular cortex, and other brain regions involved in pain processing and modulation among different groups. CONCLUSION: It is referred that these brain regions with altered regional homogeneity might be related to the pain processing and modulation of CH.