Categories
Headaches

What factors determine lumbar puncture opening pressures?

Population-based evaluation of lumbar puncture opening pressures.

Wang F, Lesser ER, Cutsforth-Gregory JK, et al.

Front Neurol 2019; 10:899.

Abstract

Background:

Prior studies evaluating opening pressure (OP) have mostly involved lumbar puncture (LP) for diagnosis of neurologic disease or small cohorts of healthy volunteers and therefore the normal OP is not well-defined.

Methods:

The goal of this study was to establish the normal range of OP in a community-based population using the Mayo Clinic Study of Aging (MCSA) and to evaluate factors that contribute to OP variability. Design: LP OP were obtained from participants aged 32-95 years between 11/1/07 and 10/1/17, as part of routine data collection for the MCSA, a longitudinal, population-based study of residents of Olmsted County, Minnesota. Setting: A longitudinal, population-based study of residents of Olmsted County, Minnesota. Participants: There were 639 participants (56.8% male; 98.5% white) who underwent LP with recorded OP as part of the MCSA. Intervention: LP. Main Outcome(s) and Measure(s): LP OP was recorded along with variables that could possibly influence its variability, including age, body mass index (BMI), and obstructive sleep apnea (OSA).

Results:

Six hundred thirty-nine participants (56.8% men) underwent LP with recorded OP; average age was 71.0 years (SD 10.9) with a mean BMI of 28.0 (SD 4.6). Mean OP was 155.4 mmH2O (SD 41.9) with a 95% reference interval of 82-242 mmH2O (range 60-314; Q1, Q3: 124, 182). Increasing age was associated with lower OP (p < 0.001), while increasing BMI was associated with higher OP (p < 0.001). Twelve (2%) participants had OP ≥ 250 mmH2O; they were younger [58.5 (SD 8.2), p < 0.001], had higher BMI [33.6 (SD 4.6), p < 0.001], and were more likely to have OSA (75%, p < 0.001). Among the 79 participants with repeat LPs within 2.5 years, the coefficient of repeatability (CR) was 64.9. Ten (12.7%) had an OP difference ≥50 mmH2O between serial LPs.

Conclusions:

This large population-based study showed that lumbar puncture opening pressure can vary significantly among individuals. Higher opening pressures were associated with higher body mass index and younger age.

This paper is cited in the neurochecklist:

Idiopathic intracranial hypertension (IIH): lumbar puncture

Abstract link

By Robert L. Dickinson – New York Medical Journal, Public Domain, Link
Categories
Headaches

Does IIH increase the risk of cerebrovascular events?

Association between idiopathic intracranial hypertension and risk of cardiovascular diseases in women in the United Kingdom.

Adderley NJ, Subramanian A, Nirantharakumar K, et al.

JAMA Neurol 2019 (Epub ahead of print).

Abstract

BACKGROUND:

Cardiovascular disease (CVD) risk has not been previously evaluated in a large matched cohort study in idiopathic intracranial hypertension (IIH).

OBJECTIVES:

To estimate the risk of composite cardiovascular events, heart failure, ischemic heart disease, stroke/transient ischemic attack (TIA), type 2 diabetes, and hypertension in women with idiopathic intracranial hypertension and compare it with the risk in women, matched on body mass index (BMI) and age, without the condition; and to evaluate the prevalence and incidence of IIH.

METHODS:

This population-based matched controlled cohort study used 28 years of data, from January 1, 1990, to January 17, 2018, from The Health Improvement Network (THIN), an anonymized, nationally representative electronic medical records database in the United Kingdom. All female patients aged 16 years or older were eligible for inclusion. Female patients with IIH (n = 2760) were included and randomly matched with up to 10 control patients (n = 27 125) by BMI and age.

RESULTS:

In total, 2760 women with IIH and 27 125 women without IIH were included. Age and BMI were similar between the 2 groups, with a median (interquartile range) age of 32.1 (25.6-42.0) years in the exposed group and 32.1 (25.7-42.1) years in the control group; in the exposed group 1728 women (62.6%) were obese, and in the control group 16514 women (60.9%) were obese. Higher absolute risks for all cardiovascular outcomes were observed in women with IIH compared with control patients. The aHRs were as follows: composite cardiovascular events, 2.10 (95% CI, 1.61-2.74; P < .001); heart failure, 1.97 (95% CI, 1.16-3.37; P = .01); ischemic heart disease, 1.94 (95% CI, 1.27-2.94; P = .002); stroke/TIA, 2.27 (95% CI, 1.61-3.21; P < .001); type 2 diabetes, 1.30 (95% CI, 1.07-1.57; P = .009); and hypertension, 1.55 (95% CI, 1.30-1.84; P < .001). The incidence of IIH in female patients more than tripled between 2005 and 2017, from 2.5 to 9.3 per 100 000 person-years. Similarly, IIH prevalence increased in the same period, from 26 to 79 per 100 000 women. Incidence increased markedly with BMI higher than 30.

CONCLUSIONS:

Idiopathic intracranial hypertension in women appeared to be associated with a 2-fold increase in cerebrovascular disease risk; change in patient care to modify risk factors for CVD may reduce long-term morbidity for women with IIH and warrants further evaluation.

This paper is cited in the neurochecklist:

Idiopathic intracranial hypertension (IIH): typical clinical features 

Abstract link

Internet Archive Book Images on Flickr. https://www.flickr.com/photos/internetarchivebookimages/14586373420/
Categories
Headaches

Do cluster headache attacks increase the risk of suicide?

Increased suicidality in patients with cluster headache.

Ji Lee M, Cho SJ, Wook Park J, et al.

Cephalalgia 2019; 39:1249-1256.

Abstract

OBJECTIVE:

To investigate suicidality related to cluster headache and factors associated with increased suicidality in cluster headache patients.

METHODS:

In this multicenter study, 193 cluster headache patients were recruited between September 2016 and August 2018. Patients were asked about their suicidality during and between attacks, specifically about passive suicidal ideation, active suicidal ideation, suicide plan, and suicide attempt. Univariable and multivariable logistic regression analyses were performed to evaluate the factors associated with high ictal suicidality (sum of positive response ≥ 2). Patients were followed up when they were in the between-bouts period.

RESULTS:

A total of 175 cluster headache patients in the in-bout period were included in this study. Passive suicidal ideation, active suicidal ideation, suicidal planning, and suicidal attempt were reported by 111 (64.2%), 62 (35.8%), 10 (5.8%), and four (2.3%) patients during attacks; seven (4.0%), six (3.5%), five (2.9%) and two (1.2%) patients interictally; and none (0%), one (1.9%), one (1.9%), and none (0%) among patients in the between-bouts period. Factors associated with high ictal suicidality were longer disease duration, the Headache Impact Test score, and the Patient Health Question-9 score (multivariable OR = 1.90 per 10-year increase in disease duration, 95% CI = 1.18-3.05, p = 0.008; multivariable OR = 3.19 per 10-point increase in HIT-6, 95% CI = 1.73-5.87, p < 0.001; multivariable OR = 2.11 per 10-point increase in PHQ-9, 95% CI = 1.13-3.95, p = 0.020, respectively).

CONCLUSIONS:

Cluster headache attack carries a high suicidality compared to the interictal or between-bouts state. An intensive treatment to reduce cluster headache burden may be helpful to alleviate suicide risk in cluster headache patients.

Also see:

Trejo-Gabriel-Galan JM, Aicua-Rapún I, Cubo-Delgado E, Velasco-Bernal C. Suicide in primary headaches in 48 countries: a physician-survey based study. Cephalalgia 2017: 38:798-803.

Both papers are cited in the neurochecklist:

Cluster headache (CH): clinical features

Abstract link 1

Abstract link 2

By JD Fletcher – http://arowmaker.tripod.com/AROWMAKER/id6.html, CC BY-SA 3.0, Povezava
Categories
Headaches

What is the ideal CSF closing pressure at lumbar puncture for IIH?

Cerebrospinal fluid removal for idiopathic intracranial hypertension: less cerebrospinal fluid is best

Perloff MD, Parikh SK, Fiorito-Torres F, McAdams MT, Rayhill ML.

J Neuroophthalmol 2019; 39:330-332.

Abstract

BACKGROUND:

Although lumbar punctures (LPs) are used for diagnostic evaluation in idiopathic intracranial hypertension (IIH), they can also provide relief from IIH-associated headache. Conversely, low-pressure headache secondary to LP can be debilitating. Low-volume cerebrospinal fluid (CSF) removal to a “high-normal” closing pressure (CP), approximately 18-20 cm H2O, may result in relief of IIH-associated headache with a lowered frequency of post-LP headache.

METHODS:

We conducted a single-center retrospective analysis from 2011 to 2016 of patients who underwent fluoroscopic LPs aiming for high-normal CPs. Inclusion criteria were as follows: 1) pre-existing diagnosis of IIH, or opening pressure (OP) and clinical findings diagnostic for IIH; 2) height and weight recorded within 1 year; 3) documented LP data parameters; and 4) one week post-LP follow-up documenting whether headache was worse, unchanged, or better.

RESULTS:

One hundred forty-six patients met the inclusion criteria. Mean age was 34.9 years ± 11.0, and mean body mass index was 39.2 kg/m ± 10.5. Mean volume removed was 9.7 mL ± 4.6. The mean CP was 17.9 cm H2O ±2.7. The mean pressure change (OP-CP) per volume removed was 1.50 cm H2O/mL ±0.6. Headache symptoms at follow-up were improved in 64% (80/125) of patients, worse in 26% (33/125), and unchanged in 10% (12/125). Eleven patients were headache-free, and 11 patients required hospital care for post-LP headache.

CONCLUSIONS:

Low-volume CSF removal to approximately 18 cm H2O resulted in relief of IIH-associated headache in most patients and a low incidence of post-LP headache. Although clinically variable, these data suggest that for every 1 mL of CSF removed, the CP decreases approximately 1.5 cm H2O.

This paper is cited in the neurochecklist:

Idiopathic intracranial hypertension (IIH): other investigations

Abstract link

By unknown, maybe L.A. Marty, M.D, Kansas City (author of other photographies in this book) – Sophian, Abraham: Epidemic cerebrospinal meningitis (1913), St. Louis, C.V Mosby, p. 171 (Scan from archive.org)., Public Domain, Link
Categories
Headaches

Does migraine reduce the risk of diabetes?

Associations between migraine and type 2 diabetes in women: findings from the E3N Cohort Study

Fagherazzi G, El Fatouhi D, Fournier A, et al.

JAMA Neurol 2019; 76:257-263.

Abstract

BACKGROUND:

Little is known about the associations between migraine and type 2 diabetes and the temporality of the association between these 2 diseases. To evaluate the association between migraine and type 2 diabetes incidence as well as the evolution of the prevalence of active migraine before and after type 2 diabetes diagnosis.

METHODS:

We used data from the E3N cohort study, a French prospective population-based study initiated in 1990 on a cohort of women born between 1925 and 1950. The E3N study participants are insured by a health insurance plan that mostly covers teachers. From the eligible women in the E3N study, we included those who completed the 2002 follow-up questionnaire with information available on migraine. We then excluded prevalent cases of type 2 diabetes, leaving a final sample of women who were followed up between 2004 and 2014. All potential occurrences of type 2 diabetes were identified through a drug reimbursement database. Statistical analyses were performed in March 2018.

RESULTS:

From the 98 995 women in the study, 76 403 women completed the 2002 follow-up survey. Of these, 2156 were excluded because they had type 2 diabetes, leaving 74 247 women. Participants had a mean (SD) age of 61 (6) years at baseline, and all were free of type 2 diabetes. During 10 years of follow-up, 2372 incident type 2 diabetes cases occurred. A lower risk of type 2 diabetes was observed for women with active migraine compared with women with no migraine history (univariate hazard ratio, 0.80 [95% CI, 0.67-0.96], multivariable-adjusted hazard ratio, 0.70 [95% CI, 0.58-0.85]). We also observed a linear decrease in active migraine prevalence from 22% (95% CI, 16%-27%) to 11% (95% CI, 10%-12%) during the 24 years prior to diabetes diagnosis, after adjustment for potential type 2 diabetes risk factors. A plateau of migraine prevalence around 11% was then observed for 22 years after diagnosis.

CONCLUSIONS:

We observed a lower risk of developing type 2 diabetes for women with active migraine and a decrease in active migraine prevalence prior to diabetes diagnosis. Further targeted research should focus on understanding the mechanisms involved in explaining these findings.

This paper is cited in the neurochecklist:

Migraine: risk factors

Abstract link

By Reversing Your Diabetes Today – http://reversingyourdiabetestoday.com/https://pixabay.com/en/diabetes-blood-finger-glucose-777001/, CC0, Link
Categories
Epilepsy Headaches Multiple sclerosis Muscular dystrophy Myasthenia gravis Neurology of Pregnancy Neuromyelitis optica Parkinson's disease Sleep disorders Stroke

21 practical and handy obstetric neurology checklists

Obstetric neurology is stepping out of the shadows

Expertise is expanding, and so is the knowledge

Guidelines are sprouting, and care is getting specialized

It is difficult to keep up with the rapid pace of developments

But neurochecklists can help.

For a taster, here are 21 handy and practical checklists

Indispensable, we may add

By Pilirodriguezhttp://www.elblogdetubebe.com/que-es-la-preeclampsia-y-como-evitarla-en-el-embarazo/, CC BY-SA 4.0, Link

Preeclampsia: management

Epilepsy: management in pregnancy

Anti-epileptic drugs (AEDs) in pregnancy

Anti-epileptic drugs (AEDs): teratogenicity

Stroke in pregnancy: management

Migraine treatment in pregnancy

Migraine treatment and lactation: acute drugs

Headache imaging in pregnancy

Pregnancy and myasthenia gravis (MG): management

Pregnancy and multiple sclerosis (MS): management

Lactation and multiple sclerosis (MS): management 

Pregnancy and neuromyelitis optica (NMO)

Pregnancy and unruptured arteriovenous malformations (AVMs): management

Pregnancy and cerebral aneurysms

Pregnancy and cerebral vein thrombosis (CVT)

Pregnancy and idiopathic intracranial hypertension (IIH)

Pregnancy and Parkinson’s disease (PD)

Pregnancy and myotonic dystrophy

Pregnancy and Chiari malformation

Pregnancy and narcolepsy

Neurological complications of labour

Pregnancy and miscellaneous neurological disorders

***

Try them out, and leave a feedback!

By FunkyxianOwn work, CC BY-SA 4.0, Link
Categories
Headaches

What is the stroke risk of contraceptives in people with migraine?

 Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC). 

Sacco S, Merki-Feld GS, Ægidius KL, et al

J Headache Pain 2017; 18:108.

Abstract

Background:

Several data indicate that migraine, especially migraine with aura, is associated with an increased risk of ischemic stroke and other vascular events. Of concern is whether the risk of ischemic stroke in migraineurs is magnified by the use of hormonal contraceptives. As migraine prevalence is high in women of reproductive age, it is common to face the issue of migraine and hormonal contraceptive use in clinical practice.

Methodology:

In this document, we systematically reviewed data about the association between migraine, ischemic stroke and hormonal contraceptive use. Thereafter a consensus procedure among international experts was done to develop statements to support clinical decision making, in terms of cardiovascular safety, for prescription of hormonal contraceptives to women with migraine.

Results:

Overall, quality of current evidence regarding the risk of ischemic stroke in migraineurs associated with the use of hormonal contraceptives is low. Available data suggest that combined hormonal contraceptive may further increase the risk of ischemic stroke in those who have migraine, specifically migraine with aura.

Conclusions:

Thus, our current statements privilege safety and provide several suggestions to try to avoid possible risks. As the quality of available data is poor further research is needed on this topic to increase safe use of hormonal contraceptives in women with migraine.

See also:

Champaloux SW, Tepper NK, Monsour M, et al. Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke. Am J Obstet Gynecol 2017; 216:489.e1-489.e7.

Both references are cited in the neurochecklist:

Migraine and stroke: contraceptive risk

By BetteDavisEyes at English Wikipedia – Transferred from en.wikipedia to Commons.; transfer was stated to be made by Tanvir., Public Domain, Link

Abstract link 1

Abstract link 2

Categories
Headaches

Is migraine a risk for suicide?

Association of suicide risk with headache frequency among migraine patients with and without aura.

Lin YK, Liang CS, Lee JT, et al.

Front Neurol 2019; 10:228.

Abstract

Background:

Migraines with aura have been associated with suicide in adolescents and young adults, but the association between suicide and migraine frequency has not been determined. This study investigated suicidal ideation and suicide attempts among patients with varying frequencies of migraines, with and without auras.

Methods:

This cross-sectional study analyzed 528 patients aged between 20 and 60 years from a headache outpatient clinic in Taiwan. All patients completed a set of questionnaires, including a demographic questionnaire, the Migraine Disability Assessment questionnaire, the Hospital Anxiety and Depression Scale, the Beck Depression Inventory, and the Pittsburgh Sleep Quality Index. Suicide risk was evaluated by self-reported lifetime suicidal  ideation and attempts. Patients were divided into low-frequency (1-4 days/month), moderate-frequency (5-8 days/month), high-frequency (9-14 days/month), and chronic (≥15 days/month) migraine groups. The association between migraine frequency and suicidality was investigated using multivariable linear regression and logistic regression.

Results:

The rates of suicidal ideation and suicide attempts were the highest for chronic migraine with aura (ideation: 47.2%; attempts: 13.9%) and lowest in migraine-free controls (2.8%). Migraine frequency was an independent risk factor for suicidal ideation and attempts in patients with aura (both P trend < 0.001), but not in patients without aurasMigraine aura and depression were associated with higher risks of suicidal ideation and suicide attempts in patients with migraine.

Conclusion:

High migraine frequency has a correlation with high suicide risk in patients who experience an aura, but not in other patients with migraine.

This paper is cited in the neurochecklist

Migraine co-morbidities

Abstract link

The only consolation was this beautiful flower at Suicide Point. Shankar S on Flickr. https://www.flickr.com/photos/shankaronline/28484079831
Categories
Headaches

Is detoxification effective for medication overuse headache?

Medication-overuse headache detoxification reduces headache disability-the Akershus study of chronic headache

Kristoffersen ES, Grande RB, Aaseth K, Russell MB, Lundqvist C

Eur J Neurol 2018; 25:1140-1147.

Abstract

BACKGROUND:

Medication-overuse headache (MOH) is a chronic headache (≥15 days/month) associated with overuse of acute headache medication. The objective was to investigate headache-related disability before and after self-detoxification from MOH in the general population, as well as possible predictors for successful outcome.

METHODS:

This was a prospective cohort study. Participants were identified in a cross-sectional epidemiological sample of 30 000 persons aged 30-44 from the general Norwegian population. People with MOH received short information about the possible role of medication overuse in headache chronification. A total of 108 of the 128 participants (84%) were eligible for follow-up 1.5 years later.

RESULTS:

Using the Migraine Disability Assessment (MIDAS), people with MOH in the general population were heavily disabled (mean MIDAS score 42.1, 95% confidence interval 31.7-52.6) with a majority in the severe disability class. The MIDAS score was significantly reduced at follow-up (P < 0.001) for those with successful self-detoxification. In multivariate analyses, co-occurrence of migraine (P = 0.044) and lower headache frequency at baseline (P = 0.001) increased the odds for successful self-detoxification and reversion to episodic headache.

CONCLUSION:

Medication-overuse headache causes substantial disability in the general population. Self-detoxification leads to reduced headache frequency and disability, although 24% of the participants did not complete self-detoxification. Detoxification should be offered to medication overuse headache patients as early as possible with a focus on headache frequency, disability and psychological distress.

This paper is now cited in the Neurochecklist:

Medication overuse headache (MOH): treatment

Abstract link

Drugs firms ‘creating ills for every pill’. publik15 on Flickr. https://www.flickr.com/photos/publik15/3415531899