Episodic dural stimulation in conscious rhesus monkey: A model for recurrent migraine
N. Chen, L. He, J. Guo, W. Su, M.K. Zhou
Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
Objectives: To establish a recurrent migraine model in conscious rhesus monkey with episodic dural stimulation.
Background: Several migraine models have been established based on epidural stimulation, however, most of these are built based on single stimulation, while migraineur experiences repeated dural nociceptive activation, In addition, clinical trials in patients have been failed to confirm the efficacy of the anti-migraine drugs which was once useful in this models. Therefore, a recurrent headache model in conscious rhesus monkey might be a potential choice for preclinical migraine study.
Method: Inflammatory soup was infused into dural to induce inflammation through indwelling catheter. The infusion started at 8th day and repeated every 3 days until to the 23th day. We performed behavioral assessment and detected the expression of c-fos, nNOS and CGRP immuno-reactivity in multiple brain areas.
Results: In stimulation group, 2 monkeys showed an increased ipsilateral nose and mouth secretions, 3 showed a disability for daily activities in the period between stimulus. None of these was found in sham-operation group. The stimulation group also presented more c-fos-positive neurons than control group did. Higher expression of c-fos, nNOS and CGRP were found in various brain areas, in particular, expression of c-fos shows a positive linear correlation to nNOS in the inferior medulla oblongata (r = 0.955, p = 0.045).
Conclusion: Repeated IS stimulation of the dura produced a migraine-like pathologic change and abnormal behaviors in conscious rhesus monkey model. Immunohistochemical analysis suggested a wide pathologic changes across whole brain. Therefore, this model might be a potential choice for preclinical migraine study.
LP-02
Migraine Pathophysiology and Treatment
Calcitonin gene–related peptide induced migraine attacks in patients with high and low genetic load
G. Song, A.F. Christensen, M.L. Liu, B.N. Janjooa, J. Olesen, A. Messoud
Department of Neurology, Danish Headache Center, Glostrup, Denmark
Background: Genome wide association studies (GWAS) have identified single nucleotide polymorphisms (SNPs) to be associated with migraine without aura (MO), but their functional roles are yet unclear. Intravenous infusion of calcitonin gene–related peptide (CGRP) provokes migraine attacks in migraine sufferers. Whether SNPs or family history contribute to migraine susceptibility to CGRP infusion is unknown.
Hypothesis: MO-patients with a high genetic load of SNPs associated with MO (≥14 risk alleles) or a family history of migraine (≥2 first-degree relatives with migraine) report more migraine attacks after CGRP administration than patients with a low genetic load (≤9 risk alleles) or no family history (≤1 first-degree relatives with migraine).
Methods: We conducted a randomized, double-blinded study in 20 genotyped MO-patients with high genetic load and 20 genotyped MO-patients with low genetic load. All participants received intravenous infusion of 1.5 µg/min human α-CGRP. Family history of migraine was obtained by telephone interview using a validated semi-structured questionnaire.
Results: We found no difference in the incidence of migraine-like attacks between patients with high and low (65% vs. 60%) genetic load after CGRP infusion (p = 0.744). In addition, CGRP infusion did not induce more migraine-like attacks in MO-patients with a family history of migraine compared to patients without family history (75% vs. 52%) (p = 0.150).
Conclusion: This is the first functional study of a relation between genetics of MO and migraine provocation. We demonstrated that neither the currently known SNPs associated with MO nor family history can explain the hypersensitivity of MO patients to CGRP infusion.
LP-03
Migraine Pathophysiology and Treatment
A retrospective study in the treatment of menstrual migraine: Comparison of the new multidisciplinary approach with the mono-disciplinary approach
J.S.P. van den Berg, H. Witteveen
Neurology, Isala, Zwolle, Netherlands
Introduction: Menstrual migraine (MM) is a disabling headache disorder; mainly treated only a neurologist. A multidisciplinary clinic where these patients receive treatment from both a neurologist and gynecologist at the same time seems more convenient.
Aim of the study: To investigate whether a multidisciplinary approach of MM is superior to the mono-disciplinary treatment which was performed before 2012.
Method: This retrospective study was done using data of 88 women with MM who visited the menstrual migraine clinic between March 2012 and December 2014. Follow-up took place after 3, 6 and 9 months. The results were compared to a control group, containing women with MM who were seen before 2012 and received a mono-disciplinary approach.
Results: The HIT score improved significantly from 65 points at baseline to 59 points after 9 months. The improvement of HIT score in the control group was less striking (from 65 to 63.5 points). Headache days per month declined in the intervention group from 6 to 3.83 days, while this even increased in the control group (from 6 to 6.5 days). The number of days using pain medication, also showed a significant difference at evaluation in favor of the intervention group. It appeared that 20 out of 27 patients in the control group already required a multidisciplinary approach in course of time, because they were referred to a gynecologist after visiting the neurologist.
Conclusion: A multidisciplinary approach for MM gives better results than a mono-disciplinary approach.
LP-04
Migraine Pathophysiology and Treatment
Forecasting individual headache attacks: Longitudinal study
1Anesthesiology, Wake Forest Baptist Medical Center, Winston- Salem, USA
2Neurology, Wake Forest Baptist Medical Center, Winston- Salem, USA
3Neurology, Neurology and Pain Consultants, Winston- Salem, USA
4Medicine, University of Cincinnati College of Medicine, Cincinatti, USA
Objective: To develop and validate a prediction model that forecasts future migraine attacks for an individual headache sufferer.
Design: Longitudinal design with Bayesian prediction models.
Setting: Single-site research center in North Carolina, USA; September 2009 to May 2014.
Participants: 95 participants with episodic migraine with or without aura contributed 4624 days of diary data.
Intervention: Individual headache forecasts were derived from current headache state and current levels of stress using several aspects of the Daily Stress Inventory (DSI), a measure of daily hassles that is completed at the end of each day.
Main Outcome Measure: The presence/absence of any headache attack (head pain > 0 on a numerical rating scale of 0 to 10) over the next 24 hour period.
Results: Participants in the study experienced a headache on 1239 of 4624 days (26.7%). A simple forecast model using either the frequency of stressful events or the perceived intensity of these events fit the data as well as more complex models that utilized previous days’ stress levels or changes in stress from day-to-day. This simple forecasting model possessed promising predictive utility with an AUC of 0.72 (95%CI: 0.65 to 0.75).
Conclusion: This study demonstrates that future headache attacks can be forecasted for a diverse group of individuals over time. The use of Bayesian methods allows individuals to benefit from the past experience of others while enabling forecasts to be delivered immediately (i.e., without having to build an entirely new model for each person).
LP-05
Migraine Pathophysiology and Treatment
Gait and balance impairments in migraine patients: Do we need to offer vestibular rehabilitation?
J. Sugrue1, R. Forbes2, L. Cummins3, D. Meldrum3, M. Ruttledge4
Background: In the absence of concurrent vestibular disorders, it is unknown whether dizziness and disequilibrium commonly associated with migraine are subjective symptoms only or if patients have impairments in gait and balance.
Aim: To quantify balance and gait outcomes in patients with migraine.
Methods: This was an observational study. Patient were recruited from secondary care between June and September 2014. The following was collected:
Patient specific information – gender and age
Headache specific information – diagnosis, frequency and severity of migraine
Dizziness/disequilibrium information – frequency, severity, relationship to headache
Physical Outcome Measures – Balance was assessed using Computerised Dynamic Posturography (specifically the Sensory Organisation Test, SOT), and gait was measured with Functional Gait Assessment (FGA).
Descriptive statistics were derived from Excel.
Results: Over the 6 week period, 21 patients completed testing – a response rate of 26%.
95% had a diagnosis of migraine.
95% were female, with mean age 42 years
Mean frequency was 15 headache days per month
90% of the migraine patients reported experiencing dizziness or disequilibrium
Mean FGA score was 29 – within normal range.
Mean SOT composite balance scores was 65 – below normal
Conclusion: A high prevalence of dizziness and disequilibrium was found in migraine patients attending secondary care. This was associated with objective signs of imbalance using computerised dynamic posturography No abnormalities of gait were found. Further research is needed to establish if a vestibular rehabilitation intervention targeted at those migraine patients who have objective signs of imbalance will improve symptoms.
LP-06
Migraine Pathophysiology and Treatment
Migraine headache heritability – twin study
M. Knezevic-Pogancev
Developmental neurology and epileptology, Child and youth halth care Institute of Vojvodina, Novi Sad, Serbia
The aim of this research was to determine heritability of migraine among twin pairs.
Heritability of migraine was investigated by analyzing twins aged 3 to 21 years, on the territory of Northern Province of Serbia with its population of around 3 million people and more than 20 different nationalities. By the method of random sampling 792 twins were surveyed. 396 twin pairs (42,4% monozygotic and 57,6% dizygotic). Within the group 30.2% had recurrent headaches, 21% non-migraine recurrent headaches and 9.2% migraine, (10.1% monozygotic and 8.3% dizygotic).
The concordance for the migraine is 94.1% for monozygotic twins and 57.9% for dizygotic ones, a significant difference (p < 0.05). The heritability quotient for the migraine with monozygotic twins was calculated by using Holzinger`s formula and it is 0.8598. The concordance for the non-migraine was 50.0% for monozygotic and 59.3% for dizygotic twins.
Heritability quotient of 0,3882 confirms the significance of heritability, but,at the same time, it confirms the effect of environmental factors on the appearance of recurrent headaches as well. Migraine syndrome with heritability quotient of 0,8598 clearly shows the hereditability of the migraine.
The very high correlation quotient of the migraine syndrome of all twins r12 0,7498; r2 12 56,12%, (r12 0,8458; r2 12 1,54% of monozygotic and r12 0,6342; r2 12 40,22% of dizygotic) and the determination quotient of the migraine for all the twins 56.12% (71.54% for monozygotic, and 40.22% for dizygotic twins) show high degree of mutual dependence between the migraine of twin siblings, more important with monozygotic twins.
LP-07
Migraine Pathophysiology and Treatment
Open label effectiveness of sphenopalatine ganglion (SPG) stimulation for high-disability migraine headache – pathway M-1 study interim acute results
R. Jensen1, K. Paemeleire2, A. Goodman3, A. Caparso3, M. Láinez4
1Danish Headache Center, Glostrup Hospital University of Copenhagen, Glostrup, Denmark
2Department of Neurology, Ghent University Hospital, Ghent, Belgium
3Clinical Research, Autonomic Technologies Inc., Redwood City, USA
4Department of Neurology, Hospital Clinico Universitario Universidad de Valencia, Valencia, Spain
Background: The Pathway M-1 study is a randomized, sham-controlled pilot study of sphenopalatine ganglion (SPG) stimulation with the ATI neurostimulator, for migraine headache. Patients represented a heterogeneous, refractory, highly-disabled population and experienced at least 8 days/month migraine attacks.
Aim: The aim of this interim analysis is to evaluate acute effectiveness of SPG stimulation for refractory, high-disability migraine through one year following insertion of an SPG neurostimulator.
Method: Therapeutic effectiveness (acute pain response following SPG stimulation) was analyzed for all evaluable SPG stimulation attempts through one year. Sham and prophylactic stimulations were excluded. Effective therapy was relief from ≥ moderate pain, or freedom from or lack of progression of mild pain, evaluated at 1 or 2 hours following stimulation, as appropriate. As SPG stimulation has no dose limitations, therapy was used as needed/desired.
Results: 33 patients across three European centers underwent insertion of the ATI Neurostimulator. 31 used SPG stimulation acutely, an average of 83.3 evaluable times (range 5-246), through one year post-insertion. 49% of N = 2581 treatments achieved Effective Therapy. 58% (18/31) of evaluable patients were considered responders, experiencing Effective Therapy in at least 50% of attacks.
Conclusion: These open label, interim results indicate that SPG stimulation effectively treats pain or keeps mild pain from progressing in a majority of migraine patients implanted with the ATI Neurostimulator. Given these results in this refractory, highly-disabled population, continued research to refine the population of likely responders is warranted.
LP-08
Migraine Pathophysiology and Treatment
Chiari malformation type 0 (CM0) and hemicrania
S. Lobzin, E. Yurkina
Chair of Neurology named after S.N. Davidenkov, North-Western State Medical University n. a. I.I. Mechnikov, Saint Petersburg, Russia
Background: early and frequent subjective symptoms at MK I is headache, often localized in the suboccipital. However, some researchers have paid attention to hemicrania with MK I. R.S. Tubbs proposed in 2001 – “Chiari zero malformation”.
Aim: clinical and morphometric features in patients with MK0
Methods and materials: magnetic resonance imaging, magnetic resonance angiography (MRA), radiography craniovertebral junction, were performed in 22 patients (6 men, 16 women) with CM0 and 17 in the control group. We were to determine the total posterior cranial fossa volume (PFCV), using the method of numerical integration.
Results: the main complaint was headache – 20 patients (90,9 %); hemicrania – 9 (40,9%). Was described by Russian neurologist V.S. Lobzin in 1977, like a “three twins syndrome” migraine (cholecystopatya, arterial hypotension and hemicrania). We have identified this syndrome in all patients with CM 0 and hemicrania. Neurological signs presented: “cross” syndrome in 72,7%, “pyramidal” syndrome in 22,7%, cerebellar disorders in 68,5% cases. MRA founds: lack of posterior communicating artery in 45,4 % (10 patients), unilateral trifurcation posterior – 4,5 % (1), hypoplasia of the right vertebral artery – in 45,4% (10), left – in 13,6 % (3), embryonic trigeminal artery in 4,5 % (1) cases. The PFCV in patients with CM0 (162,0 ± 6,86 sm3) was smaller (p < 0,01), than in the control group (168,9 ± 8,65 sm3)
Conclusion: these data allow to suppose that angiodysplasia of vessels in posterior cranial fossa (PCF), the congenitally hypoplastic PCF, migraine at patients with CM0 have the general deviation in an embryogenesis.
LP-09
Migraine Pathophysiology and Treatment
Treatment cost analysis of chronic migraine patients in the UK NHS setting
F. Ahmed1, R. Bhola2
1Neurology, Hull and East Yorkshire NHS Hospitals Trust, Hull, United Kingdom
2Neurology, eNeura UK, London, United Kingdom
Background: Chronic migraine patients suffer from a considerable burden of disease with only few treatment options being available. Botulinum toxin type A (BOTOX) is the only licensed treatment recommended by NICE (2011) through technology appraisal guidance (TAG) for which commissioners are obliged to provide funding. Transcranial magnetic stimulation (TMS) has been appraised by NICE through Interventional procedure guidance (IPG) for which funding on the NHS is not mandatory. UK migraine clinics are starting to use TMS, hence the objective of this cost analysis was to compare treatment costs of Botox and TMS over one year.
Methods: A Markov model was developed in order to obtain validated patient number being treated per quarter. Treatment costs for BOTOX (£349 per cycle) were based on published NICE appraisal figures. TMS cost applied were £450 per cycle acknowledging the fact that based on a risk-sharing scheme only responders are subject for payment.
Results: During the modeling horizon of one year a mean responder rate of 36% was expected in both groups. Since the TMS treatment costs are only reimbursable for responders, the annual cost per average patient from a NHS perspective would be £2,208 compared to £2.405 for BOTOX.
Discussion: Risk-sharing scheme based costs for TMS are lower compared to BOTOX in a conservative scenario. Future cost analyses have to include current costs resulting from different CCG serving these severely affected patients.
LP-10
Migraine Pathophysiology and Treatment
Effect of occipital nerve stimulation on central pain processing in patients with chronic migraine
C. Göbel1, S. Clasen2, A. Göbel1, A. Heinze2, K. Heinze-Kuhn2, I. Petersen2, C. Meinecke2, U. Niederberger3, D. Rasche4, H.M. Mehdorn5, H. Göbel2
1Clinic for Neurology, University of Luebeck, Lübeck, Germany
2Kiel, Headache and Pain Centre, Kiel, Germany
3Department for Psychology, University of Kiel, Kiel, Germany
4Department for Neurosurgery, University of Luebeck, Lübeck, Germany
5Department for Neurosurgery, University of Kiel, Kiel, Germany
Background: Occipital Nerve stimulation (ONS) is a treatment option for therapy-resistant chronic migraine. The precise effect of ONS onto the pathophysiology of migraine and the trigeminocervicale antinociceptive system remains unknown. In this study, the effect of ONS onto experimentally induced pain and antinociceptive reflexes in patients with chronic migraine is assessed.
Methods: 10 patients treated with ONS due to chronic migraine participated in this within-subject-design study. Experimental conditions were assessed on two days with stimulation either switched on or off. Order of conditions was balanced. To determine trigeminal antinociceptive activity, we analysed quantitatively the corneal reflex (CR) by measuring the blink frequency over one minute triggered by a standardised stream of air to the eyes. Additionally, we analysed the exteroceptive suppression of temporalis muscle activity (ES).
Results: During active stimulation, blink frequency (CR) was significantly reduced compared to without stimulation in standardised corneal irritation (p = 0.014). Also we found a significantly lengthened duration of ES1 (p = 0.040) and a lengthened duration of ES2 during active ONS compared to deactivated ONS (p = 0.085).
Conclusion: The data show that ONS activates antinociceptive cervicotrigeminal systems. Pain-alleviating reflex mechanisms are activated and the central nervous system is protected from aversive inputs.
LP-11
Migraine Pathophysiology and Treatment
Headache attributed to pituitary hyposecretion: GH deficiency in a child
M. Tenuta, G.P. Volpe, A. Glielmi, P. Siano, A. Trotta, G. Capo
Neuroscienze, A.O.U.San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
Background: The International Classification of Headache Disorders 3rd Edition β version(ICHD-3 beta) include in code classification 7.4.3 the diagnosis Headache Attributed to Hypothalamic or Pituitary Hyper- or Hyposecretion
The Diagnostic criteria comprehend headache has developed in temporal relation to onset pituitary hyposecretion and headache has significantly improved in parallel with improvement in the pituitary hyposecretion
Patient: We observed a patient 9 years with a frontal headache arose a few months. This boy had a normal neurological examination but he appeared to short stature when compared to parents. A auxological evaluation show stature < 2DS and growth velocity < -1DS for age and sex. The bone age was delayed by about two years. Was performed for evaluation of hypotalamic-pituitary axis to GH that showed a severe hormone deficiency. Was diagnosed idiophatic GH deficiency with growth failure due to inadequate secretion of growth hormone.
Treatment and Results: The patient was treated with recombinant GH therapy (Zomacton Ferring 0.20 mg/Kg body weigth) with a recovery of the rate of growth and disappareance of specific headache
Conclusion: The idiopatic GH deficiency can be a cause of headache attributed to pituitary hyposecretion.
The correct treatment by recombinant GH for this disease has significantly improved in parallel with replacement therapy for the pituitary hyposecretion.
LP-12
Primary Headaches Pathophysiology and Treatment
New theory in treatment of headache
J. Elrefai
Emergency and Diving Medicine Department, Royal Medical Servises, Amman, Jordan
Objectives: this prospective study over seven hundred of people who suffer from chronic and sever type of headache who were treated by applying definition and explaining of theorized causes of their headache.
Explanation of theory: whatever the cause of nasal congestion or blockage and or whatever the cause of decreased air flow through the nasal cavity, will not ventilate sufficiently the sinuses, that inducing elevation in the internal temperature of the sinus cavity, that will not allow the brain to lose its temperature, that cause increasing of the temperature of the brain tissue which enhance the vasodilatation of the brain vessels and increasing the intracranial pressure, that explain the headache.
Methods: we performed a special data sheet with the consent form to be applied by the patient, all patients suffer from headache for not less than one year, were investigated to exclude secondary headache, we used a modified intensive inspirometer to calculate the amount of air entry from the mouth and from both nostrils; we used the ten score pain scale pictures.
Results: male to female ratio were 8.3:1.7; 88% decreased nasal air flow, 8% respiratory, and 47% mixed;. 91% of them were cured or passed without treatment; 3% had respiratory problems, 5% psychological causes mainly depression, and 4% had severe form of nasal septum deviation or chronic sinusitis.
Discussion: we can investigate our theory by applying this study over thousands of patients at a special centers, using some other modified techniques.
LP-13
Primary Headaches Pathophysiology and Treatment
Peripheral nerve field stimulation for trigeminal neuropathic pain syndromes and persistent idiopathic facial pain
J. Klein, S. Sandi-Gahun, G. Schackert, T.A. Juratli
Department of Neurosurgery, University Hospital Carl Gustav Carus, Dresden, Germany
Background: Peripheral nerve field stimulation (PNFS) is a promising modality for treatment of intractable facial pain. However, evidence is sparse.
Aim: To evaluate the potential use of this technique in a small patient cohort.
Methods: Records of 10 patients (5 men, 5 women) with intractable facial pain who underwent implantation of one or several subcutaneous electrodes for trigeminal nerve field stimulation were retrospectively analyzed. Patients’ data, including pain location, etiology, duration, previous treatments, long-term effects and complications, were evaluated. All patients gave written informed consent for publication of their data.
Results: Four patients suffered from recurrent classical trigeminal neuralgia, one had classical trigeminal neuralgia and was medically unfit for microvascular decompression. Two patients suffered from trigeminal neuropathy attributed to multiple sclerosis, one from post-herpetic neuropathy, one from trigeminal neuropathy following radiation therapy and one from persistent idiopathic facial pain. Average patient age was 74.2 years (range 57–87), and average symptom duration was 10.6 years (range 2–17). Eight patients proceeded to implantation after successful trial. Average follow-up after implantation was 11.3 months (range 5–28). Using the visual analogue scale, average pain intensity was 9.3 (range 7–10) preoperatively and 0.6 (range 0–3) postoperatively. Six patients reported absence of pain with stimulation; two had only a slight constant pain without attacks.
Conclusion: PNFS may be an effective treatment for refractory facial pain and yields a high patient satisfaction.
LP-14
Primary Headaches Pathophysiology and Treatment
Use of the Non-medication in the Treatment of Tension-type Headache
O. Tondiy
Neurology and Child Neurology, Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
Background and Aims: The effect of the complex (acupuncture, d’arsonval currents and variable magnetic field) on the pain intensity of the patients having tension-type headache was investigated.
Method: 80 patients aged from 18 to 55 (51 females and 29 males) having tension – type headache were observed. The pain was examined and measured according to the visual analogue scale (6 –7 points). All patients were observed (MRI, doppler ultrasound vesselsof the head and neck, spondylography etc.)
The patients were divided into two groups. The first group (62 patients) received in addition their basic medication and complex: acupuncture (GI 4, GI 11, E 36, RP 6, P 7, MC 6, TR 5, F 2, IG 3, T 12–18, T 20, IG 10, IG 12 – 15, GI 14 – 16, V 7 –15, VB 19 – 21, VB 3 – 9, TR 17, TR 21 – 23, VB 1, V 2 – 6, VB 14 – 16, T 22 – 24); variable magnetic field to the neck paravertebrally and d’arsonval current on the scalp, on neck and shoulder region. The complete course was 10 – 12 procedures. The second group (control,18 patients), received only the basic medication.
Result: The pain intensity of the patients in the first group was reduced after 6 – 7 days of treatment (96,7% patients) compared to the control group, where pain reduction after 12 – 16 days of treatment (44,4% patients); p < 0,01.
Conclusion: The addition of the acupuncture, variable magnrtic fieldand and d’arsonval current to the treatment of tension-type headache resulted in earlier remission.
LP-15
Primary Headaches Pathophysiology and Treatment
Eye pain and secondary headache in the course of infection caused by Demodex
I. Chudzicka-Strugala1, E. Madry2, A. Kwan2, W. Chudzicki3
1Department of Medical Microbiology PUMS, Poznan University of Medical Sciences, Poznan, Poland
2Department of Physiology PUMS, Poznan University of Medical Sciences, Poznan, Poland
3Poznan ophtalomology Unit Practice, Ophtalomology Unit, Poznan, Poland
Demodex is a parasite. Exists in hair follicles and sebaceous glands of the skin. There are two main species pathogenic for people: Demodex folliculorum and brevis.
Changes are most often located near nose, around the eyes, on the forehead, chin and other parts of the body. Can also induce a chalazions, or acne rosacea.
Demodex can induce blepharitis or blepharoconjunctivitis.
Objective: Demonstration of the incidence of eye and head pain in the course of infection with Demodex.
Material and methods:: The investigated group included 320 patients (180 women and 140 men 25–82 years old) with blepharitis or blepharoconjunctivits with eye pain, swelling of the eyelids, and haedache. Each patient was previously treated with long-term neurological ophthalmologist and no effects.
The diagnostics material included parasitology nad microbiology examination. Were epilated 4 eyelashes from each eyelid and also swab from conjunctivita for bacteriological culure. Eyelashes were placed on slide in 10% KOH. Under the microscope (100X) was observe presence or no forms of Demodex. To culturing used blood agar and sellective agar.
Results: In 290 (90%)(160 (88,9%) women and 130 (93%) men) patients showed the presence of occurrence Demodex.
In 30 (9%) patients, 14 women and 16 men were S. aureus bacterial co-infection or S.epidermidis.
Conclusion:
Patients with chronic blepharitis or blepharoconjunctivitis with pain eyes should be taken after the ophtalmic examination make parasitological and bacteriological investigation.
Eyestrain in the course of Demodex cause secondary headaches temporal and frontal.
Exact microbiological diagnostics will reduce the costs of treatment and diagnosis
LP-16
Primary Headaches Pathophysiology and Treatment
Risk factors of headache in children in Cheongju, Korea
W. Kim1, G. Sin2
1Pediatrics, Chungbuk Natl Univ Hospital, Cheongju, Korea
2Pediatrics, Saint MaryHospital, Cheongju, Korea
Background: Headache is an extremely frequent symptom in childhood and adolescence, and a common reason for neurological consultation. So we studied risk factors that cause headache to children or adolescence in Cheongju, korea.
Methods: In this study, 596 children were asked whether they had a headache at march 2014. And we analyzed according to grade, sex, excercise, eating breakfast, sleep time, caffeine intake.
Results: The prevalence of headache in Cheongju is 20.5%. The migraine is 11% and tension headache is 5.8%. And 30% of high school students has headache, 21% of middle school students has headache and 16.6% of elementary school students has headache. P value is 0.002. High school students has more severe headache than middle school students or elementary school students. High school students has the fewer mean sleep time of high school students the more severe headache (P 0.069).
Students taking caffeine has more severe headache than students not taking caffeine.
Conclusion:This study is the primary study of the headache prevalence and the headache risk. And this study is the starting point about headache study in Cheongju, Korea.
LP-17
Primary Headaches Pathophysiology and Treatment
Tension-type headache, anxiety and prophylaxis with duloxetine
P.E. Bermejo, R. Dorado, B. Belarrinaga
Headache Unit, Hospital Los Madroños, Brunete, Spain
Objectives: Although some prophylactic medications have been proposed to treat tension-type headache (TTH) there are still many refractory patients and others are warranted. Duloxetine is a serotonin-norepinephrine reuptake inhibitor, effective for major depressive disorder and generalized anxiety disorder. As known, anxiety is frequently associated with TTH. The aim of this study is to evaluate the efficacy and tolerability of duloxetine for patients with refractory chronic tension type headache and anxiety.
Methods: 43 patients with refractory chronic tension type headache according to International Headache Society criteria and anxiety were enrolled in this study. Headache frequency (days per month), headache severity (according to the Visual Analogical Scale) and anxiety (according to Hamilton Scale) associated before and after treatment initiation with duloxetine were compared. The patients had failed an average of 3.4 prophylactic drugs prior to duloxetine. The average duloxetine daily dose was 58 mg and the average duration of treatment was 121 days.
Results: The average number of days with headache per month was reduced in the entire study population from 19.4 before duloxetin treatment to 15.1 after its initiation; headache severity was reduced from 7.1 to 5.1, and anxiety was reduced, from 22.1 to 17.2. Duloxetine was well tolerated, the principal adverse event was somnolence and none patient abandoned the treatment for that reason.
Conclusion: Duloxetine has efficacy in TTH and anxiety reduction. According to our results, this drug may be a safe and effective agent in patients with TTH and anxiety. Double-blind studies are warranted to confirm these findings.
