Investigating the effects of weather on headache occurrence using a smartphone application and artificial intelligence: A retrospective observational cross-sectional study.

OBJECTIVE: To investigate the relationship between weather and headache occurrence using big data from an electronic headache diary smartphone application with recent statistical and deep learning (DL)-based methods. BACKGROUND: The relationship between weather and headache occurrence remains unknown. METHODS: From a database of 1 million users, data from 4375 users with 336,951 hourly headache events and weather data from December 2020 to November 2021 were analyzed. We developed statistical and DL-based models to predict the number of hourly headache occurrences mainly from weather factors. Temporal validation was performed using data from December 2019 to November 2020. Apart from the user dataset used in this model development, the physician-diagnosed headache prevalence was gathered. RESULTS: Of the 40,617 respondents, 15,127/40,617 (37.2%) users experienced physician-diagnosed migraine, and 2458/40,617 (6.1%) users had physician-diagnosed non-migraine headaches. The mean (standard deviation) age of the 4375 filtered users was 34 (11.2) years, and 89.2% were female (3902/4375). Lower barometric pressure (p < 0.001, gain = 3.9), higher humidity (p < 0.001, gain = 7.1), more rainfall (p < 0.001, gain = 3.1), a significant decrease in barometric pressure 6 h before (p < 0.001, gain = 11.7), higher barometric pressure at 6:00 a.m. on the day (p < 0.001, gain = 4.6), lower barometric pressure on the next day (p < 0.001, gain = 6.7), and raw time-series barometric type I (remaining low around headache attack, p < 0.001, gain = 10.1) and type II (decreasing around headache attack, p < 0.001, gain = 10.1) changes over 6 days, were significantly associated with headache occurrences in both the statistical and DL-based models. For temporal validation, the root mean squared error (RMSE) was 13.4, and the determination coefficient (R2 ) was 52.9% for the statistical model. The RMSE was 10.2, and the R2 was 53.7% for the DL-based model. CONCLUSIONS: Using big data, we found that low barometric pressure, barometric pressure changes, higher humidity, and rainfall were associated with an increased number of headache occurrences.

Relationship between Energy Intake and Changes in Thigh Echo Intensity during the Acute Phase of Stroke in Older Patients with Hemiplegia.

OBJECTIVE: The aim of this study was to investigate the relationship between energy intake and changes in thigh echo intensity (TEI) during the acute phase of stroke in older patients with hemiplegia. SUBJECTS AND METHODS: Older hemiplegic inpatients with stroke were enrolled in this post hoc analysis of a prospective observational study. Patients were divided into 2 groups according to energy intake during the 7 days after admission as follows: energy sufficient (ES) and energy insufficient (EIS) groups. The outcome was the rate of changes in TEI of the paralyzed and nonparalyzed sides between admission and after 4 weeks. A decrease in skeletal muscle quality is defined as an increase in intramuscular adipose tissues, which shows as an increase in echo intensity. RESULTS: The study included 44 males and 39 females (median age 81 years). The rate of change of TEI in each group was as follows: +4.5% in the ES/paralyzed group, +6.7% in the EIS/paralyzed group, -0.9% in the ES/nonparalyzed group, and +4.4% in the EIS/nonparalyzed group. The univariate analyses showed no significant difference in the rate of change in TEI between ES and EIS groups in both paralyzed side (p = 0.190) and nonparalyzed side (p = 0.183). Multivariate analysis showed that higher energy intake was associated with a smaller increase in the rate of change in TEI on the nonparalyzed side (B = -4.115, 95% confidence interval, -7.127 to -1.103). CONCLUSIONS: Higher energy intake during 7 days after admission was associated with a smaller increase in the rate of change in TEI on the nonparalyzed side upon admission and after 4 weeks.

The Controlling Nutritional Status score as a functional prognostic marker in patients with acute stroke: A multicenter retrospective cohort study.

OBJECTIVE: The aim of this study was to assess whether undernutrition on hospital admission, as evaluated by the Controlling Nutritional Status (CONUT) score, has an effect on the improvement in functional and cognitive activities of daily living (ADL) in adult patients with acute stroke. METHODS: We retrospectively analyzed data of patients ≥20 y of age with acute stroke between July 2015 and June 2017 in the Noto Liaison Council for Cerebral Stroke of Japan database. We divided the patients into two groups based in CONUT score on admission: high CONUT (5-12), indicating undernutrition, and low CONUT (0 -4), indicating no undernutrition. The Functional Independence Measure (FIM) and FIM gain were used to evaluate the patient disability level and change in patient status in response to rehabilitation. RESULTS: Data for 702 patients were extracted from the database. Of the 702 patients, 47.6% were women. A significant difference was found in the motor FIM gain between the two groups. A low CONUT score on admission was independently associated with motor FIM gain (partial regression coefficient ß = -2.874; 95% confidence interval [CI], -5.470 to -0.278). In contrast, a low CONUT score on admission was not independently associated with cognitive FIM gain (ß = -0.229; 95% CI, -0.889 to 0.430). CONCLUSIONS: Undernutrition as determined by the CONUT score on admission was an independent predictor of poor motor FIM gain in adult patients with acute stroke. It was not an independent predictor for poor cognitive FIM gain.

Energy intake during the acute phase and changes in femoral muscle thickness in older hemiplegic inpatients with stroke.

OBJECTIVE: The purpose of this study was to clarify the relationship between changes in lower limb muscle mass and energy intake during the acute phase in older hemiplegic inpatients with stroke. METHODS: A prospective cohort study was performed in 157 consecutive older patients with stroke. Patients were categorized into two groups of energy sufficiency/non-sufficiency based on their daily energy intake during the first week after admission, and compared with regard to change in femur muscle thickness (ΔFMT) between admission and after the four-week period in paralysis/non-paralysis limbs. FMT was determined using B-mode ultrasound imaging with an 8-MHz transducer. RESULTS: The study included 42 men and 54 women (mean age 81 T 6 y). At one week after admission, 57 patients were classified into the energy sufficiency group, and 39 were in the energy shortage group. ΔFMT in each group: -3.7 ± 5.1 mm in the paralysis/sufficiency group, -5.2 ± 5.2 mm in the paralysis/shortage group, -1.5 ± 3.9 mm in the non-paralysis/sufficiency group and -3.9 ± 3.2 mm in the non-paralysis/shortage group. No significant difference was observed in the ΔFMT between the sufficiency group and the non-sufficiency group in the paralysis limb (P = 0.159); a significant difference was observed in the non-paralysis limb (P = 0.002). The multivariate regression analysis showed that energy sufficiency were independently associated with ΔFMT in the non-paralysis limb (unadjusted coefficient = 1.592; 95% confidence interval = 0.072 to 3.112, P = 0.040). CONCLUSIONS: Energy intake could affect ΔFMT on the non-paralysis side in older stroke inpatients.

Topographic Analysis of Electroencephalographic Changes during Photic Driving Responses in Patients with Migraine.

OBJECTIVE: Migraineurs demonstrate abnormal information processing such as photic hypersensitivity. The photic driving response to photic stimulation (PS) is a reaction to the visual stimulation of electroencephalography (EEG). Both the photic driving response and photic hypersensitivity appear during light stimulation. We considered that evaluation of a migraineur's photic driving response may help to elucidate the mechanism of the migraineur's sensitive condition. Our study aimed to investigate EEG photic driving responses with a source-localizing method. METHODS: We recorded spontaneous resting EEG with eyes closed from 20 electrodes on the scalp during the interictal phase. After recording, each PS was separately selected. We also analyzed EEG by fast Fourier transform and observed the spectrum frequency peaks and topographies in response to PS. RESULTS: The photic driving response could be observed at a flashing rate of >15 Hz. Patients with photic hypersensitivity tended to show more photic driving regardless of the migraine subtype. Moreover, in topographies, their activated areas were shifted anteriorly from fundamental driving to harmonic driving for each photic frequency. This anterior shift was more evident with a longer duration of illness, although no significant differences were seen between migraine subtypes. The global field power value had a positive correlation with the duration of illness. CONCLUSION: Photic hypersensitivity and photic driving responses were increased in migraineurs. Photic hypersensitivity might result in sensitization of the limbic system. © 2015 S. Karger AG, Basel.

[Monitoring cerebral blood volume changes during migraine attack by using near-infrared spectroscopy].

The pathophysiology of migraine includes the vascular theory, the trigeminovascular theory, and cortical spreading depression; however, the pathophysiology of a spontaneous migraine attack has not yet been clarified. The vascular theory became negative, and it was considered that the pain of migraine was not associated with vascular expansion. However, recent studies have again attracted attention toward the vascular theory of migraine. The aim of the present study was to provide effective tools for monitoring hemodynamic changes in the cortical and scalp surface during migraine attack and treatment. Using a near-infrared spectroscopy system and laser doppler skin blood flow (SkBF) monitoring device in combination, we monitored changes in extra- and intracranial vasculature upon sumatriptan injection during spontaneous migraine attack. There was a marked reduction of oxy-Hb/SkBF in all patients after sumatriptan injection, and this was consistent with pain relief. Moreover, the changes in oxy-Hb and SkBF were significantly correlated. In contrast, saline injection did not cause any significant changes. These data suggest that sumatriptan induces the vasoconstriction of the vascular bed region, including the arteriovenous anastomosis in the scalp and cortex. On the basis of these data, we suggest that it is now justifiable to reconsider the vascular theory of migraine.

Recurrent aseptic meningitis in association with Kikuchi-Fujimoto disease: case report and literature review.

BACKGROUND: Kikuchi Fujimoto disease (KFD), or histiocytic necrotising lymphadenitis, is a benign and self-limiting condition characterised by primarily affecting the cervical lymph nodes. Recurrent aseptic meningitis in association with KFD is extremely rare and remains a diagnostic challenge. CASE PRESENTATION: We report a 28-year-old man who presented 7 episodes of aseptic meningitis associated with KFD over the course of 7 years. Histopathological findings of enlarged lymph nodes led to the diagnosis of KFD. The patient's headache and lymphadenopathy spontaneously resolved without any sequelae. CONCLUSIONS: A diagnosis of KFD should be considered when enlarged cervical lymph nodes are observed in patients with recurrent aseptic meningitis. A long-term prognosis remains uncertain, and careful follow-up is preferred.

Influence of barometric pressure in patients with migraine headache.

OBJECTIVE: Barometric pressure has been reported as a triggering and exacerbating factor in migraine headaches, although there are few reports concerning the association of weather change and migraine headache. The relationship between barometric pressure changes and migraine headaches was prospectively examined. METHODS: A total of 28 migraine patients who lived within 10 km of the Utsunomiya Local Meteorological Observatory kept a headache diary throughout the year. Daily and monthly mean barometric pressure data of the Utsunomiya Local Meteorological Observatory were obtained via the homepage of the Meteorological Office. RESULTS: The correlation between headache frequency obtained by the headache diaries for 1 year and changes in the barometric pressure during the period of 2 days before and 2 days after the headache onset were evaluated. The frequency of migraine increased when the difference in barometric pressure from the day the headache occurred to the day after was lower by more than 5 hPa, and decreased when the difference in barometric pressure from the day the headache occurred to 2 days later was higher by more than 5 hPa. Of 28 patients, weather change was associated with migraine headache development in 18 (64%) patients, 14 of which reported low barometric pressure to be a cause of headache. There was no association between the monthly mean barometric pressure and headache frequency throughout the year. CONCLUSION: Barometric pressure change can be one of the exacerbating factors of migraine headaches.

Monitoring cortical hemodynamic changes after sumatriptan injection during migraine attack by near-infrared spectroscopy.

The aim of the present study is to provide effective tools for monitoring hemodynamic changes in the cortical and scalp surface during migraine attack and treatment. Using near-infrared spectroscopy system (NIRS) and laser Doppler skin blood flow (SkBF) devices in combination, we monitored changes in extra- and intra-cranial vasculature states upon sumatriptan injection during spontaneous migraine attack. We examined 4 control subjects and 4 migraine patients. Multi-channel NIRS probes were placed over the temporoparietal area bilaterally and oxygenated hemoglobin (oxy-Hb) was analyzed. Laser Doppler SkBF was simultaneously recorded to measure scalp surface blood flow changes. All patients were treated with a sumatriptan injection (3 mg), and all control subjects received a saline injection as a control for oxy-Hb/SkBF signals caused by injection pain over the monitoring period. There was a marked reduction of oxy-Hb/SkBF in all patients after sumatriptan injection, consistent with pain relief. Moreover, the changes in oxy-Hb/SkBF were significantly correlated. By contrast, saline injection did not cause any significant changes. These data suggest that sumatriptan induces blood vessel contraction at both cortical and scalp surfaces. Simultaneous oxy-Hb/SkBF recording enables real-time continuous monitoring of the effects of sumatriptan treatment in clinical situations.

[Details about the first medical examinations of patients with Guillain-Barré or Fisher syndromes].

Randomized controlled trials have shown beneficial responses to plasma exchange and intravenous immunoglobulin in Guillain-Barré syndrome (GBS), but details about the first medical examination of patients with GBS and Fisher syndrome (FS) have not been reported. We investigated the period from first consultations to treatment after the onset of patients with GBS and FS. A questionnaire was used to collect informations on 247 patients with GBS and 125 with FS, all of whom had been referred to our neuroimmunological laboratory informations between January 2001 and October 2001 for serum anti-ganglioside antibody tests. A letter of inquiry was sent to the primary physicians; 150 (61%) patients with GBS and 72 (58%) with FS responded validly. Patients with GBS generally consulted an internist [58%, neurologist (21%)] or orthopedist (17%), those with FS an internist [52%, neurologist (26%)] or ophthalmologist (25%). Consultation with a neurologist usually came after one with a physician. We conclude that physicians should be aware that patients may have GBS or FS, and that such recognition is useful for early diagnosis and treatment of these syndromes.