Background and Purpose—The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audienc...

/pdf/guidelines-for-the-early-management-of-patients-with-acute-19udbft6e7.pdf

Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

The 3rd edition of the International Classification of Headache Disorders (ICHD-3) may be reproduced freely for scientific, educational or clinical uses by institutions, societies or individuals. Otherwise, copyright belongs exclusively to the International Headache Society. Reproduction of any part or parts in any manner for commercial uses requires the Society’s permission, which will be granted on payment of a fee. Please contact the publisher at the address below. International Headache Society 2013–2018. Applications for copyright permissions should be submitted to Sage Publications Ltd, 1 Oliver’s Yard, 55 City Road, London EC1Y 1SP, United Kingdom (tel: þ44 (0) 207 324 8500; fax: þ44 (0) 207 324 8600; permissions@sagepub.co.uk) (www.uk.sagepub.com). Translations

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition

https://bic.berkeley.edu/sites/default/files/Rossi_09_TMS%20safety%20review.pdf

Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research

OBJECTIVE — To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management. RESEARCH DESIGN AND METHODS — We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence. RESULTS — Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower (10% in most studies) than it was 3 decades ago. The type of immunosuppression explained 74% of the variability in incidence (P 0.0004). Risk factors were patient age, nonwhite ethnicity, glucocorticoid treatment for rejection, and immunosuppression with high-dose cyclosporine and tacrolimus. PTD was associated with decreased graft and patient survival in earlier studies; later studies showed improved outcomes. Randomized trials of treatment regimens have not been conducted. CONCLUSIONS — Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs. Diabetes Care 25:583–592, 2002

A systematic review of the literature

Theta Burst Stimulation of the Human Motor Cortex

A 37-year-old man developed an ipsilateral headache which fulfilled the criteria for cluster headache after orbital extenteration because of a traumatic lesion of the bulb. The headache could be treated successfully by drugs usually applied in the therapy of cluster headache. Six similar cases of cluster headache after orbital exenteration could be identified in the literature suggesting that the eye itself is not necessarily part of the pathogenesis of cluster headache. We hypothesize that orbital exenteration can cause cluster headache by lesions of sympathetic structures. Possibly, these mechanisms are similar to those of sympathetic reflex dystrophy (Sudeck-Leriche syndrome) causing pain of the limbs.

Cluster headache after orbital exenteration.

BackgroundSeveral treatment guidelines exist for cluster headache. However, it is not yet known how many cluster headache patients are treated according to these guidelines.MethodsWe enrolled 434 cluster headache patients with confirmed diagnosis referred to two tertiary pain centers. The history of treatment was registered and analyzed according to the treatment guidelines of the European Federation of Neurological Societies.ResultsRegarding acute attack treatment, 62.1% of the episodic and 71.0% of the chronic cluster headache patients were treated according to the guidelines. The efficacy rate was above 92% in both groups. Regarding prophylactic treatment, 31.3% of the episodic and 50.9% of the chronic cluster headache patients were treated according to the guidelines. The efficacy rate was 92.8% for episodic and 70.9% for chronic cluster headache.ConclusionThe rate of guideline-adherent treatment in cluster headache is about 70% for acute treatment and about 35% for prophylactic treatment. The efficac...

Evaluation of guideline-adherent treatment in cluster headache.

Cervicogenic headache has always been a controversial issue in headache research, diagnosis and treatment. However, with the development of clinical criteria for cervicogenic headache, systematic research has been made possible and has shown that cervicogenic headache is a real entity but is also over-diagnosed by patients and many nonheadache specialists. In addition, basic research on the convergence of upper cervical spine afferents and trigeminal pathways has given the possibility to explain referred pain as the underlying mechanism of the perception of cervicogenic headache. A change in the view of cervicogenic headache can also be seen in the development of the classification of the International Headache Society. In the first classification (1988), cervicogenic headache had been defined as an unspecific headache caused by any disturbance of the cervical spine. In the revision (2003), cervicogenic headache was considered a specific entity with specific criteria. These criteria, however, are not very useful because they are in some way arbitrary. For scientific purposes, the criteria of the Cervicogenic Headache International Study Group (CHISG) are useful and have been applied in a lot of clinical studies (1). All classification systems have in common that they do not necessarily demand imaging of the cervical spine. This is important because many patients and colleagues believe that the underlying mechanisms of cervicogenic headache can be seen in an X-ray or a scan of the cervical spine. We know today that cervicogenic headache is a dysfunction of the upper cervical spine rather than structural damage. If one applies the scientific criteria for cervicogenic headache, a prevalence of 1% in a populationbased study using the IHS criteria (2) and of 2.5% (95% confidence interval 1.1% to 4.8%) using the first CHISG criteria (3) could be observed. The percentage of cervicogenic headache with respect to all severe headache types has been calculated to be 17.8 (95% confidence interval 8.0% to 32.0%). This underlines the importance of this headache type in daily practice. Cervicogenic headache is a pain experienced in the region of the first trigeminal branch but originating from the first three cervical segments. The underlying mechanism is that of convergence. On the spinal level, cervical and trigeminal afferents converge (4). By this principle, one can explain why functional disturbances of the upper cervical spine can lead to temporal or frontal pain. However, this principle also explains the reverse situation: pain originating from the first trigeminal branch can be experienced in the neck and in the upper cervical spine. This is often the case in migraine patients. The anatomical structures involved in the pathophysiology of cervicogenic headache are afferent fibres only from the first three cervical segments (5). These afferents have their nociceptors in the joints of the upper cervical spine and in the connective and muscle tissue around the spine. In patients with cervicogenic headache, blockades of different cervical structures with local anaesthetics led to a decrease of pain or even to freedom from pain. The most prominent effects were obtained when the suboccipital muscles, the atlanto-occipital joint, the atlanto-axial joint, the upper zygapophyseal joints, the greater occipital nerve, or the so-called third occipital nerve were blocked. The exact mechanisms leading to cervicogenic headache, however, are still not detected. Why do some patients exhibit pain due to mild functional abnormalities of the upper cervical spine whereas other patients with severe structural and functional damage of the upper cervical spine have nearly no pain? What are the central nociceptive mechanisms leading to cervicogenic headache? Is there a

Comparison of cervicogenic headache with migraine

BackgroundExploding head syndrome (EHS) is characterized by attacks of a sudden noise or explosive feeling experienced in the head occurring during the transition from wake to sleep or from sleep t...

Exploding head syndrome: Six new cases and review of the literature

Mutations in the NOTCH3 gene cause cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Exons 3 and 4 are mutation hotspots. Migraine is a clinical hallmark of CADASIL. The objective of this study was to investigate whether genetic variants in exons 3 and 4 of the NOTCH3 gene are associated with migraine. Exons 3 and 4 of the NOTCH3 were analysed for mutations and polymorphisms by direct DNA sequencing in 97 migraineurs and the same number of control individuals. No mutations in exons 3 and 4 of the NOTCH3 gene were found in 97 patients with migraine. However, association analysis revealed significant association of the single nucleotide polymorphism (SNP) rs1043994 with migraine.

Stefan Evers

Papers

Cluster headache after orbital exenteration.

Evaluation of guideline-adherent treatment in cluster headache.

Comparison of cervicogenic headache with migraine

Exploding head syndrome: Six new cases and review of the literature

Genetic variants of the NOTCH3 gene in migraine—a mutation analysis and association study