Profile of Chinese Cluster Headache Register Individual Study (CHRIS): Clinical characteristics, diagnosis and treatment status data of 816 patients in China.

BACKGROUND: The clinical profile of cluster headache may differ among different regions of the world, warranting interest in the data obtained from the initial Chinese Cluster Headache Register Individual Study (CHRIS) for better understanding. METHODS: We conducted a multicenter, prospective, longitudinal cohort study on cluster headache across all 31 provinces of China, aiming to gather clinical characteristics, treatment approaches, imaging, electrophysiological and biological samples. RESULTS: In total 816 patients were enrolled with a male-to-female ratio of 4.33:1. The mean age at consultation was 34.98 ± 9.91 years, and 24.89 ± 9.77 years at onset. Only 2.33% were diagnosed with chronic cluster headache, and 6.99% had a family history of the condition. The most common bout was one to two times per year (45.96%), lasting two weeks to one month (44.00%), and occurring frequently in spring (76.23%) and winter (73.04%). Of these, 68.50% experienced one to two attacks per day, with the majority lasting one to two hours (45.59%). The most common time for attacks was between 9 am and 12 pm (75.86%), followed by 1 am and 3 am (43.48%). Lacrimation (78.80%) was the most predominant autonomic symptom reported. Furthermore, 39.22% of patients experienced a delay of 10 years or more in receiving a correct diagnosis. Only 35.67% and 24.26% of patients received common acute and preventive treatments, respectively. CONCLUSION: Due to differences in ethnicity, genetics and lifestyle conditions, CHRIS has provided valuable baseline data from China. By establishing a dynamic cohort with comprehensive multidimensional data, it aims to advance the management system for cluster headache in China.

The effect of topiramate versus flunarizine on the non-headache symptoms of migraine.

OBJECTIVES: To investigate the impact of topiramate versus flunarizine on the non-headache symptoms (NHS) of migraine, and to observe the changes of dopamine (DA) and prolactin (PRL) before and after prophylactic treatment. METHODS: Sixty-six episodic migraine patients were enrolled and randomized 1:1 to receive either flunarizine or topiramate treatment. Clinical characteristics and NHS associated with migraine were investigated before and after prophylactic treatment. The DA and PRL levels were also determined before and after prophylactic treatment. RESULTS: The NHS of migraine in the two groups were significantly better after treatment than before treatment in premonitory phase (PP), headache phase (HP), and resolution phase (RP). The NHS in the two groups had no significant difference in PP, HP, and RP before and after treatment. In the flunarizine group, the PRL content after treatment was significantly higher than that before treatment (t = -4.097, p < 0.001), but the DA content was decreased slightly compared with that before treatment (t = 1.909, p = 0.066). There was no significant difference in PRL content (t = 1.099, p = 0.280) and DA content (t = 1.556, p = 0.130) in topiramate group before and after treatment. CONCLUSIONS: The two classical prophylactic drugs of migraine were significantly effective in treating the NHS of migraine, but there was no significant difference between the two drugs. The DA-PRL axis may be involved in the underlying mechanism of the flunarizine treatment for the NHS of migraine.

Verification of a clinical decision support system for the diagnosis of headache disorders based on patient-computer interactions: a multi-center study.

BACKGROUND: Although headache disorders are common, the current diagnostic approach is unsatisfactory. Previously, we designed a guideline-based clinical decision support system (CDSS 1.0) for diagnosing headache disorders. However, the system requires doctors to enter electronic information, which may limit widespread use. METHODS: In this study, we developed the updated CDSS 2.0, which handles clinical information acquisition via human-computer conversations conducted on personal mobile devices in an outpatient setting. We tested CDSS 2.0 at headache clinics in 16 hospitals in 14 provinces of China. RESULTS: Of the 653 patients recruited, 18.68% (122/652) were suspected by specialists to have secondary headaches. According to "red-flag" responses, all these participants were warned of potential secondary risks by CDSS 2.0. For the remaining 531 patients, we compared the diagnostic accuracy of assessments made using only electronic data firstly. In Comparison A, the system correctly recognized 115/129 (89.15%) cases of migraine without aura (MO), 32/32 (100%) cases of migraine with aura (MA), 10/10 (100%) cases of chronic migraine (CM), 77/95 (81.05%) cases of probable migraine (PM), 11/11 (100%) cases of infrequent episodic tension-type headache (iETTH), 36/45 (80.00%) cases of frequent episodic tension-type headache (fETTH), 23/25 (92.00%) cases of chronic tension-type headache (CTTH), 53/60 (88.33%) cases of probable tension-type headache (PTTH), 8/9 (88.89%) cases of cluster headache (CH), 5/5 (100%) cases of new daily persistent headache (NDPH), and 28/29 (96.55%) cases of medication overuse headache (MOH). In Comparison B, after combining outpatient medical records, the correct recognition rates of MO (76.03%), MA (96.15%), CM (90%), PM (75.29%), iETTH (88.89%), fETTH (72.73%), CTTH (95.65%), PTTH (79.66%), CH (77.78%), NDPH (80%), and MOH (84.85%) were still satisfactory. A patient satisfaction survey indicated that the conversational questionnaire was very well accepted, with high levels of satisfaction reported by 852 patients. CONCLUSIONS: The CDSS 2.0 achieved high diagnostic accuracy for most primary and some secondary headaches. Human-computer conversation data were well integrated into the diagnostic process, and the system was well accepted by patients. The follow-up process and doctor-client interactions will be future areas of research for the development of CDSS for headaches.

Cognitive Dysfunction in Migraineurs.

Background and Objectives: Migraines are one of the most common types of primary headaches in neurology. Many studies to date have investigated cognitive impairment in migraineurs, but the results are inconsistent. This study aimed to investigate the cognitive function of migraineurs and explore the influencing factors. Material and Methods: A total of 117 patients with primary headaches (87 with migraine and 30 with tension-type headache (TTH)) and 30 healthy controls were enrolled. General information and data on headache clinical characteristics, and assessments of headache-related disability, psychological symptoms, and cognitive function were collected for statistical analysis. Results: The Montreal Cognitive Assessment (MoCA) total score and the scores of visuospatial and executive functions, language, and delayed recall in the migraine and TTH groups were significantly lower than those in the healthy control group (all p < 0.05). The MoCA total score did not correlate with Headache impact test-6, Migraine Disability Assessment Questionnaire, Patient Health Questionnaire-9, or Generalized Anxiety Disorder Questionnaire-7 scores in migraineurs (all p > 0.0125). The multiple linear regression analysis showed that age and duration of attack had a major influence on the overall and various fields of cognition in migraineurs. Conclusion: The study confirmed the impairment of cognitive function in patients with migraine and TTH, and found that the duration of attack had an effect on cognitive function in migraineurs.

Decision difficulties of long-term-care facility nurses in transferring residents to the emergency department: A cross-sectional nationwide study.

AIMS: To examine the level of decision difficulties of long-term-care facility (LTCF) nurses when transferring residents to the emergency department (ED) and associated influencing factors. DESIGN: A cross-sectional nationwide study. METHODS: The LTCFs were selected through random stratified sampling across the whole Taiwan during February 2018 to January 2019. LTCF nurses who met the selection criteria were invited to participate with two or three nurses selected from each LTCF. The Patient Transfer Decision Difficulty Scale (PTDDS) was used to measure the level of difficulty in making decisions related to the transfer of residents to the ED. Data were collected by mailing the questionnaires and asking the nurses to return the completed form in 2 weeks. Data were analysed using simple linear regression and multiple regression with stepwise methods. RESULTS: In total, 618 valid questionnaires with an 85.32% response rate from 319 LTCFs were used for the data analysis. Decision difficulties that LTCF nurses experienced were moderate, the nursing personnel-bed ratio, LTCF professional training and basic life support training were predictive factors of the level of difficulty experience (scores of PTDDS) for the LTCF nurse (F = 6.81, p < .001). CONCLUSIONS: Enhancing emergency training in LTCF can improve nurses' decision-making ability to refer LTCF residents to emergency treatment. IMPACT: What problem did the study address? The study addressed the difficult decision LTCF nurses may experience when transferring a resident to the emergency department. What were the main findings? All LTCF nurses faced a moderate level of difficulty in decision-making. 'Transfer timing' was most often considered in the decision-making process when a resident was transferred to the ED. Where and on whom will the research have impact? Results of this study have considerable reference value for LTCF managers and nurses in the decision-making ability and suitability of transferring residents for emergency treatment.

Analysis of the characteristics of persistent postural-perceptual dizziness: A clinical-based study in China.

OBJECTIVE: Persistent postural-perceptual dizziness (PPPD) is a common cause of chronic dizziness, but only a few studies have reported its clinical characteristics, and no related research has been performed in China. Therefore, the purpose of this study was to analyze the characteristics of PPPD for the first time in China. DESIGN: Data was collected from all patients during standard clinical practice, and further to evaluate the characteristics of PPPD comparing with the control group. STUDY SAMPLE: A total of 43 patients diagnosed with PPPD were selected as the study group for analysis. RESULTS: Women were significantly more represented in the study group than men, and in the majority of cases the age of onset was in middle-age, and sleep quality was clearly decreased compared with controls, with more statistically significantly higher levels of anxiety. Personality analysis identified that neuroticism was significantly higher than in controls. CONCLUSIONS: In this sample we showed that PPPD was more represented in female patients, the age of onset was 40-60 years old, the majority of patients had sleep disorders, anxiety was the main mood disorder to be identified, and personality analysis found that neurotic personality may be the risk factor for developing PPPD. Further large scale studies are suggested in China.

Analysis of risk factors for medication-overuse headache relapse: a clinic-based study in China.

BACKGROUND: Medication overuse headache (MOH) is the third most prevalent headache type after migraine and tension-type headache. A large number of studies on the long-term prognosis have shown that MOH has a high relapse rate after treatment. Although MOH relapse-related risk factors have been reported, no related research has been performed in China. Therefore, the purpose of this study was to analyze and evaluate the risk factors for MOH relapse in China. METHODS: Eighty-six out-patients of Shandong Provincial Hospital who were initially diagnosed with MOH, and who had successful withdrawal treatment within 2 months, were chosen from March 2012 to July 2013. All subjects were followed up by the investigators of this study. Of the 86 subjects, 27 who had relapsed were compared with 59 who had not relapsed (i.e. the controls). Based on a standardized questionnaire, a database was created (with Microsoft Excel 2010). The data, which included 38 indexes, were analyzed by univariate analysis with chi-square test, Fisher's exact test, t-test, or paired rank test. The statistically correlated (P<0.05) variables were chosen as the independent variables, thereby enabling the calculation of the non-conditional multivariate stepwise logistic regression. RESULTS: The independent risk factors for medication-overuse headache relapse were determined as headache frequency before drug withdrawal, duration of primary headache, and headache frequency after drug withdrawal. CONCLUSION: Headache frequency before drug withdrawal, duration of primary headache, and headache frequency after drug withdrawal may be the independent risk factors for MOH relapse in China.

Effects of pregabalin on central sensitization in patients with migraine.

PURPOSE: Despite the fact that the most recently articulated theory of migraine is the central sensitization hypothesis, few basic and clinical research studies on central sensitization have been conducted in patients with migraine. Here, we aim to reveal the risk factors of migraine with allodynia and to illustrate the effects of pregabalin on alleviating allodynia. METHODS: 63 migraine patients meeting the International Headache Society criteria were prospectively included. The cutaneous allodynia (CA) symptoms that occurred during headache attacks were examined with the Allodynia Symptom Checklist (ASC). The risk factors of allodynia were determined using logistic regression analysis. 41 patients with allodynia were treated with pregabalin (150 - 600 mg/d) for 12 weeks. The improvements in allodynia and headache severity as well as the side effects of the drug were recorded at 1 and 3 months following drug administration. RESULTS: Among the 63 patients, there were 41 cases (65.1%) of allodynia, including 35 cases (85.4%) of thermal allodynia, 12 cases (29.4%) of static mechanical allodynia, and 9 cases (22.0%) of dynamic mechanical allodynia. The allodynia appeared to be associated with gender (female), disease duration, and medication overuse. Compared with baseline, both the ASC scores in the three types of CA and the number of patients with allodynia were significantly decreased (p < 0.05) in patients treated with pregabalin. The frequency, severity, and duration of headache as well as the migraine disability assessment (MIDAS) and headache impact test (HIT-6) scores were significantly decreased (p < 0.05) when compared with baseline. The overall efficiency of drug therapy was 85.4% among all patients who received pregabalin. There were few side effects detected, and the patients showed good tolerability to drug therapy. CONCLUSIONS: Our results showed that 65.1% of patients with migraine had allodynia and that migraine with allodynia was related to the patient gender (female), disease duration, and medication overuse. Pregabalin was effective at relieving allodynia in migraine.

Real-World Treatment Patterns and Outcomes Among Patients with Episodic Migraine in China: Results from the Adelphi Migraine Disease Specific Programme™.

Objective: This study assessed treatment patterns, disease burden, outcomes, and unmet needs among patients with episodic migraine (EM) in China using Adelphi Migraine Disease Specific Programme™ (DSP) real-world data. Background: Migraine is a prevalent and debilitating neurological disorder which presents a major public health burden globally. Research on characteristics, disease burden, and treatment patterns in EM patients in China is limited. Methods: Data were drawn from an existing data set Adelphi Migraine DSP, a point-in-time survey conducted in China (January-June 2014). Internists/neurologists completed patient record forms for the next 9 patients who consulted them in clinical practice; these same patients completed the 'patient self-completion questionnaires'. Descriptive analyses were used to assess key variables: patient demographics, treatment patterns (current acute and preventive medication [AM/PM]), effectiveness, issues with existing treatment, Migraine Disability Assessment (MIDAS) scores, and Work Productivity and Activity Impairment scores. Results: Total of 125 internists/neurologists provided data on 1113 patients with EM (headache days/month <15). Mean (standard deviation [SD]) age was 43.8 (13.1) years; mean (SD) number of migraine days/month was 3.2 (1.7). AM was prescribed in 86.1% of patients (non-steroid anti-inflammatory drugs [NSAIDs]: 62.7%; triptans: 7.7%), PM in 38.5%, and both in 24.9% of patients. Approximately 55% of patients experienced ≥1 issue with their current AM or PM. Migraine-related symptoms (including nausea, photophobia, and phonophobia) were fully controlled in <50% of patients receiving NSAIDs (21.7-38.4%) or triptans (32.4-43.5%). Insufficient response to current AM (migraine headache fully resolved within 2 hours in ≤3/5 attacks) was reported by 42.5% of patients. Mild-to-severe disability was reported by 36.8% of patients with a mean (SD) MIDAS score of 5.8 (7.3). Overall, 58.0% of work time was impaired (including time missed and impairment while working). Conclusion: This analysis suggests, despite existing treatment options, disease burden and unmet medical needs remain substantial in Chinese patients with EM.

Association between Dietary Niacin Intake and Migraine among American Adults: National Health and Nutrition Examination Survey.

Migraine is related to brain energy deficiency. Niacin is a required coenzyme in mitochondrial energy metabolism. However, the relationship between dietary niacin and migraines remains uncertain. We aimed to evaluate the relationship between dietary niacin and migraine. This study used cross-sectional data from people over 20 years old who took part in the National Health and Nutrition Examination Survey between 1999 and 2004, collecting details on their severe headaches or migraines, dietary niacin intake, and several other essential variables. There were 10,246 participants, with 20.1% (2064/10,246) who experienced migraines. Compared with individuals with lower niacin consumption Q1 (≤12.3 mg/day), the adjusted OR values for dietary niacin intake and migraine in Q2 (12.4−18.3 mg/day), Q3 (18.4−26.2 mg/day), and Q4 (≥26.3 mg/day) were 0.83 (95% CI: 0.72−0.97, p = 0.019), 0.74 (95% CI: 0.63−0.87, p < 0.001), and 0.72 (95% CI: 0.58−0.88, p = 0.001), respectively. The association between dietary niacin intake and migraine exhibited an L-shaped curve (nonlinear, p = 0.011). The OR of developing migraine was 0.975 (95% CI: 0.956−0.994, p = 0.011) in participants with niacin intake < 21.0 mg/day. The link between dietary niacin intake and migraine in US adults is L-shaped, with an inflection point of roughly 21.0 mg/day.

Relationship between non-headache symptoms and right to left shunt in episodic migraine. A single-center cross-sectional study.

The relationship between right to left shunt (RLS) and non-headache symptoms (NHS) in episodic migraine is unknown. This study aimed to investigate the incidence and classification of RLS in episodic migraineurs, calculate the occurrence rate of NHS, and analyze the associations between RLS and NHS. We consecutively recruited 204 episodic migraine patients. Contrast-enhanced transcranial doppler was adopted to screen RLS. Structured questionnaire via face-to-face survey was conducted to collect clinical data. A total of 172 episodic migraineurs were included in the final analysis, of which 20 cases were migraine with aura. The positive rate of RLS was 47.1%, of which 50 cases (29.0%) had small shunt (Grade 1) and 31 cases (18.1%) had mid-large shunt (Grade 2-4). The most common NHS was nausea (115 (66.9%)), followed by headache aggravation with physical activity (96 (55.8%)), dizziness (93 (54.1%)), vomiting (77 (44.8%)) and phonophobia (74 (43.0%)). Yawning was more common in Grade 2-4 group than Grade 0 group (p = 0.012), while no statistical differences among other groups. Grade 2-4 group had a higher rate of headache aggravation with physical activity than grade 0 group (p = 0.008). Binary logistic regression analysis showed that yawning at premonitory phase, headache aggravation with physical activity and cranial autonomic symptoms during attack are independent predictors of RLS. In conclusion, yawning and headache aggravation with physical activity are more common in migraine patients with RLS. Besides aura, particular NHS may also serve as indicators for screening RLS in episodic migraineurs.

Association between dopamine receptor D2 Taq IA gene polymorphism and persistent postural-perceptual dizziness.

BACKGROUND: Persistent postural-perceptual dizziness (PPPD) is a chronic dizziness, its pathogenesis is unknown by now. OBJECTIVE: To study the relationship between the DRD2 gene TaqIA polymorphisms and PPPD, and further to explore the molecular mechanism underlying this disease. METHODS: 43 patients diagnosed with PPPD and 45 randomly selected cases (matched by age and sex) were included in the study and control group, respectively. DRD2 gene TaqIA polymorphisms were detected in all participants by polymerase chain reaction (PCR)combined with the restriction fragment length polymorphism (RFLP) method. RESULTS: In the study group, frequencies of the A1 and A2 TaqIA alleles (65.1% and 34.9%, respectively) were significantly different to those in the control group (46.7% and 53.3%, respectively; P < 0.05). The allele frequency in the study group for the A1/A1 genotype was 34.9%, for A1/A2 was 60.5%, and for A2/A2 was 4.6%, all of which were significantly higher than the control group (24.4%, 44.5%. and 31.1%, respectively; P < 0.01). CONCLUSIONS: Our findings indicate that the DRD2 TaqIA A1 allele is possibly the susceptibility polymorphism for PPPD, and that the A2/A2 genotype has a potentially protective role for PPPD. However, larger independent studies are required for further validation.

Effects of topiramate on seizure susceptibility in kainate-kindled rats: involvement of peripheral-type benzodiazepine receptors.

This study was aimed to quantitatively evaluate the effects of topiramate (TPM) on seizure susceptibility and hippocampal peripheral-type benzodiazepine receptors (PBRs) in the kainic acid (KA) model of temporal lobe epilepsy. Male rats were randomized into saline control group, KA group, KA/TPM low dose group and KA/TPM high dose group. Three weeks after single injection of KA (10 mg kg(-1), sc), the effects of TPM were tested at two doses (10 and 30 mg kg(-1), sc) once a day for 1 week in KA/TPM low dose group or KA/TPM high dose group, respectively. Rats in KA group received comparable injections of saline. Four weeks after initial KA injection, a subconvulsant dose KA (5 mg kg(-1), sc) was administered in rats in these three groups. Rats in saline control group received equal volume of saline. All animals were decapitated and hippocampus synaptosomes were purified 180 min after behavioral observation. PBRs specific binding sites were assessed by an in vitro binding technique utilizing the highly selective ligand [(3)H]PK11195. Seizure threshold was elevated and specific PBRs binding in hippocampus was decreased by TPM in dose-dependent manner. Specific PBRs binding in hippocampus was significantly related to seizure latency and seizure intensity. These results suggest that TPM can reduce the susceptibility to seizures in KA-kindled rats and its anticonvulsant effect seems resulting from, at least in part, the reduced PBRs binding after treatment. These results also support the hypothesis that PBRs represent a novel target for antiepileptic drug development.

Clinical observation of the effect of prophylaxis on allodynia in patients with migraine.

OBJECTIVE: The clinical characteristics of migraine with and without allodynia were compared to evaluate the risk factors of cutaneous allodynia in migraine. The effects of prophylactic therapy on allodynia in patients with migraine were assessed based on the change in pain threshold after therapy. PATIENTS AND METHODS: A total of 71 patients with migraine admitted to the Department of Neurology of Shandong Provincial Hospital were recruited in this study. The included patients were aged 18-70 years and did not present positive symptoms according to the nervous system examination. The variation in cutaneous allodynia was assessed for the role of classic prophylactic therapy in migraine-related allodynia, also termed as central sensitization (CS). Patients with migraine were randomized into two groups (topiramate and flunarizine groups), and the effect of drugs was evaluated by the change in cutaneous pain threshold between the two groups. Fifty-five patients were tested for pain threshold due to instrument failure. Pressure allodynia was measured with a force gage, and pricking was measured with Electronic von Frey Anesthesiometer. The pain threshold was measured every 3 months for 6 months. The variations in pain threshold after treatment were compared using t-test and χ 2 test. RESULTS: Allodynia was seen in 70.4% of the patients; of these, 76.3% were females. Female gender, duration of illness, and frequency of migraine attacks per month were significantly associated with allodynia. The rate of allodynia and frequency of headache declined significantly, the number of patients with allodynia was reduced, and the pain threshold improved dramatically after treatment. The composite adverse events were low after treatment with topiramate and flunarizine. CONCLUSION: Allodynia was observed, especially in females who experienced frequent migraine attacks for a prolonged period. Gender, duration of illness, and number of migraine attacks per month were the major predictors of allodynia. Topiramate and flunarizine administered orally for a short duration can effectively improve the pain threshold and CS of patients with migraine, and efficiently relieve allodynia.

High-field MRS study of GABA+ in patients with migraine: response to levetiracetam treatment.

To explore alterations in γ-aminobutyric acid (GABA) levels in response to levetiracetam (LEV) treatment in patients with migraine. Patients with migraine (N=14) were treated with LEV for 12 weeks. The levels of GABA+ in the anterior cingulate cortex/medial prefrontal cortex (ACC/mPFC) and the posterior cingulate cortex (PCC) were examined by proton magnetic resonance spectroscopy before (baseline) and after treatment. LEV showed good efficacy in the reduction of headache frequency and intensity in patients with migraine. Among the 14 patients, good-quality spectral data of GABA+ in the PCC region were obtained in 11 patients. There was a significant decrease in GABA+ levels in the PCC region after LEV treatment. ACC/mPFC GABA+ was assessed by proton magnetic resonance spectroscopy in eight patients with migraine. LEV had no significant effect on GABA+ levels in the ACC/mPFC region. The decreased GABA+ levels after LEV treatment in patients with migraine suggest that GABA is a migraine biomarker.

Changes in hormones of the hypothalamic-pituitary-gonadal axis in migraine patients.

The incidence of migraine is higher in women than in men. Abnormality of the hypothalamus-pituitary-gonadal (HPG) axis is believed to be implicated in the pathogenesis of migraine. The aim of this study was to detect serum hormone levels in the HPG axis of migraineurs and analyze the relationship between the hormone levels and migraine-related clinical characteristics. One hundred and nineteen migraineurs were enrolled. Serum FSH, LH, estradiol, progesterone, testosterone, prolactin and GnRH was detected. Pain intensity and migraine-related disability were evaluated using the visual analogue scale (VAS) and the Migraine Disability Assessment questionnaire (MIDAS). The relationships between sex hormone levels and the VAS score and the MIDAS score were also examined. Progesterone levels in male migraineurs were lower than those in healthy controls (P < .01). In female patients, in the follicular phase, testosterone levels were lower than in healthy controls (P < .01). In the luteal phase, estrogen and testosterone levels (P < .05) were lower than in healthy controls. Progesterone and testosterone levels (P < .01) were lower than in healthy controls in the postmenopausal phase. In male patients, estrogen levels were negatively associated with the MIDAS score (r = -0.602). In female patients, in the follicular phase, estrogen levels were positively correlated with headache duration and VAS score (r = 0.374, r = 0.331, respectively) and negatively related with MIDAS score (r = -0.334). In the luteal phase, estrogen and progesterone levels were negatively correlated with the MIDAS score (r = -0.772, r = -0.464, respectively). The levels of HPG axis hormones were abnormal in migraineurs and were associated with migraine-related clinical characteristics.

Analysis on the risk factors of medication-overuse headache in Chinese patients.

OBJECTIVE: The purpose of this study was to analyze the risk factors of medication-overuse headache in patients with chronic migraine in China. MATERIALS AND METHODS: 157 patients who were diagnosed as chronic migraine were chosen from headache outpatients of Shandong Provincial Hospital affiliated to Shandong University. Based on a standardized questionnaire, a database was developed and analyzed with 45 indexes. RESULTS: The independent risk factors of medication-overuse headache identified in this study included the frequency of medicine overuse (OR = 9.575, 95%CI, 3.573-35.659), Allodynia Symptom Checklist scores (OR = 5.846, 95%CI, 2.065-22.856), anxiety disorder (OR = 2.902, 95%CI, 1.601-7.476) and lack or non- standardized preventive treatment (OR = 1.173, 95%CI, 1.073-3.826). CONCLUSIONS: The frequency of medicine overuse, Allodynia Symptom Checklist scores, anxiety disorder and lack or non-standardized preventive therapy were the independent risk factors for medication-overuse headache in patients with chronic migraine.

[Comparative study of mannitol-induced acute kidney impairments in patients of different ages suffering from subarachnoid hemorrhage].

OBJECTIVE: To analyze and compare the clinical characteristics of mannitol-induced acute renal function impairment in treatment of patients of different ages suffering from subarachnoid hemorrhage (SAH) for the first time. METHODS: This study was a review of 1 361 patients with available hospital records admitted to the division of neurology due to SAH from February 1989 to December 2005. Among them, 94 patients had acute renal function impairment as a result of mannitol administration. Of these patients, 35 patients were middle-aged (<60 years old) and 59 patients of old age (>60 years old). The study included the time of appearance of renal function impairment after mannitol medication, its prognosis, the administration of nephrotoxic drugs, and the dose and duration of mannitol therapy. RESULTS: In old age group, abnormal renal function and urine routine appeared in 5 days (median), and 4 days (median) respectively, and acute renal failure (ARF) was diagnosed in 5 days, and the incidence rate of ARF was 20.3% after treatment with mannitol. The respective event appeared 7 days, 11 days, 9 days and 2.8% (P<0.05 or P<0.01) respectively, in middle-aged group. The data indicated the elderly patients had poorer tolerance to mannitol, with earlier occurrence of mannitol nephrosis, poorer outcome of kidney impairment and worse prognosis. Forty-three patients (72.9%) were treated with katlex (with a median of total dosage of 400 mg) in old-aged group, 35 patients (100.0%) were treated with katlex (with a median of total dosage of 800 mg) in middle-aged group, and there was a significant difference between two groups (P<0.01). The data indicated the incidence of mannitol nephrosis was lower in patients treated with large dosage of mannitol and katlex. The mortality was 3.4% (2/59 cases) and 0% (0/35 cases) in old-aged and middle-aged groups respectively (P=0.528). CONCLUSION: The elderly patients have higher rate of mannitol-induced impairment of renal function after SAH than middle-aged patients. The data emphasize that proper combination therapy of mannitol with katlex is an effective measure in preventing renal failure.

Use of the WHOQOL-BREF for evaluating persons with traumatic brain injury.

This study examined psychometric properties of a brief version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) among persons with traumatic brain injury (TBI) and the relations of the WHOQOL-BREF domains, including physical capacity, psychological wellbeing, social relationships, and environment, to different indicators of TBI severity. Of the 354 eligible and available subjects from 22 hospitals in northern Taiwan over a 6-month period, 199 completed telephone interviews during data collection. Three indicators of TBI severity were used: the Glasgow Coma Scale, the presence of post-traumatic amnesia, and the abbreviated injury scale to the head. All domain scores of the WHOQOL-BREF had nearly symmetrical distributions: low percentages of ceiling and floor values (0-3%), low missing rates (0-0.5%) for all but one item (43.2%), and very good internal consistency (0.75-0.89) and test-retest reliability (0.74-0.95). The WHOQOL-BREF also exhibited excellent known-groups validity, as well as very good responsiveness and convergent validity with regard to employment, independence in daily life activities, social support, and depression. After adjustment for potential confounders, almost none of the domain scores of the WHOQOL-BREF significantly differed in the severity levels of the three severity indicators. In conclusion, the WHOQOL-BREF is an appropriate health-related quality of life (HRQL) instrument for persons with TBI. Furthermore, the initial severity of the TBI might not be suitable for predicting levels of HRQL in persons with TBI.

Current experiences in the use of the severe head-injury guidelines in Taiwan.

BACKGROUND: Head injury is the leading cause of death and disability for patients who experienced a major accident. It has been suggested that a well-planned neurointensive care management can effectively reduce the secondary brain insults. The BTF and the AANS proposed the Guidelines for the Management of Severe Head Injury in 1995. The purpose of this study was to obtain a consensus on whether the guidelines are suitable for treating patients with severe head injury in Taiwan. METHODS: Data from patients with severe head injury were collected from 6 different medical centers in Taiwan. The methods for controlling ICP, CPP, and hyperventilation, and the medical treatment with vasopressors and sedatives have been analyzed. RESULTS: Ninety-four patients with severe head injury (GCS