Impact of Tension-Type Headaches in the Workplace in Brazzaville

Introduction: Tension-type headaches are the most widespread of the primary headache disorders. Due to their high prevalence, tension-type headaches represent a major public health problem with an enormous socio-economic burden. Determining their impact remains a challenge. Objective: To assess the impact of occupational tension-type headache in Brazzaville and identify associated factors. Population and Methods: This was an analytical case-control study conducted in public and private companies in the city of Brazzaville over a period of four (04) months. The case population consisted of cephalalgic employees;the control population was drawn from the same companies and was free of tension-type headaches. Study variables were divided into socio-professional, clinical and individual impact variables. Individual impact variables were represented by: the HIT-6 score, which incorporates a very broad conception of disability, covering several domains, namely: severity of pain during attacks and the restrictive and limiting nature of attacks. Results: Individual impact was severe in 18 (62.1%) men and 11 (37.9%) women. Mean age was 36.3 6.14 years for cases with severe impact. The mean duration of headache was 40.3 32.7 months for cases with severe impact. Tension headache evolved in attacks in 22 (75.9%) cases with severe impact, and continuously in seven (24.1%) cases. The average number of attacks per month was 2.52 1.04 for cases with severe impact. Cases with severe impact included 14 (48.3%) with chronic headache and 15 (51.7%) with episodic headache. Pain of severe intensity present in 48.3% of cases was associated with a severe impact of tension-type headache: OR = 151.66 [2.36 - 44245.95] and p-value = 0.037. At least one days absence from work per year was observed in 47.4% of our cases. The number of days off work per year due to tension-type headache had an interquartile range between 0 and 3 days and extremes from 0 to 14 days. It was the consequence of a severe impact on daily and/or professional activities. Conclusion: The high frequency of tension-type headaches in the workplace and its impact on the condition of workers in Brazzaville represent a real public health problem. It was found that the number of days absent from work per year due to tension headaches was the consequence of a severe impact on daily and/or professional activities. An awareness-raising program in this environment seems necessary, as well as an assessment of working conditions.

Efficacy and Effect of SI17 Therapy on Pancreatic Polypeptide in Vascular and Tension-Type Headache

Background and purpose: Vascular and tension-type headache is most commonly encountered, and SI17 therapy has been tested to treat headache with good results. The efficacy of SI17 therapy for vascular and tension-type headache was compared and the effect of SI17 therapy on pancreatic polypeptide (PP) was studied. Materials and methods: 29 cases of vascular headache (20 cases in acute attack during the trial) and 27 cases of tension-type headache (19 cases in acute attack) were enrolled in the study. Plasma PP level before and 4th day after treatment was measured by radioimmunoassay. Results: SI17 therapy is better for the treatment of vascular headache. Vascular headache with higher PP level and tension-type headache with normal PP level had good therapeutic results. Conclusion: The clinical efficacy is better for vascular headache with the increase of vagus tension and for tension-type headache with normal vagus tension.

Disease-Related Factors Associated with Acupuncture Response in Patients with Chronic Tension-Type Headache:A Secondary Analysis of A Randomized Controlled Trial

Objective: To explore the demographic and disease-related factors associated with acupuncture response in patients with chronic tension-type headache(CTTH). Methods: Using data from the randomized clinical trial(218 cases) consisting of 4 weeks of baseline assessment, 8 weeks of treatment, and 24 weeks of follow-up, participants were regrouped into responders(at least a 50% reduction in monthly headache days at week 16 compared with baseline) and non-responders. Twenty-three demographic and disease-related factors associated with acupuncture response in 183 participants were analyzed by multivariable logistic regression. Results: One hundred and nineteen(65.0%) participants were classified as responders. Four factors were significantly independently associated with acupuncture response, including treatment assignment, headache intensity at baseline, and 2 domains [general health(GH) and social functioning(SF)] from the 36-Item Short Form Health Survey quality of life questionnaire. Treatment assignment was associated with nonresponse: participants receiving true acupuncture were 3-time more likely to achieve a CTTH response than those receiving superficial acupuncture [odds ratio(OR) 0.322, 95% confidence interval(CI) 0.162 to 0.625, P=0.001]. Compared with patients with mild-intensity headache, patients with moderate-intensity headache were twice as likely to respond to acupuncture(OR 2.001, 95% CI 1.020 to 4.011, P=0.046). The likelihood of non-response increased by 4.5% with each unit increase in the GH grade(OR 0.955, 95% CI 0.917 to 0.993, P=0.024) while decreased by 3.8% with each unit increase in the SF grade(OR 1.038, 95% CI 1.009 to 1.069, P=0.011). Conclusions: Greater headache intensity, lower GH score, and higher SF score were associated with better acupuncture responses in CTTH patients. These 3 factors require independent validation as predictors of acupuncture effectiveness in CTTH.

Effectiveness and safety of Xuefu Zhuyu oral liquid(血府逐瘀口服液)on Qi-stagnation and blood-stasis pattern in patients with stable angina,tension-type headache and primary dysmenorrhea:rationale and design of a master protocol

We present the rationale and design of a master protocol study that clarifies the effectiveness and safety of Chinese herbal formulas on Qi-stagnation and blood-stasis pattern(QBP).Three randomized controlled trials(RCTs)and real-world observational studies.Based on three registry cohorts of stable angina,tension-type headache and primary dysmenorrhea,patients with QBP will be enrolled in RCTs to receive either Xuefu Zhuyu(血府逐瘀,XFZY)oral liquid or a placebo,while patients with non-QBP will be enrolled in the observational studies and experience follow-up.1414 patients(RCTs:574;observational studies:840)will be recruited at seven centers in China over a 3-year period.The primary outcome is the visual analog scale of pain intensity.Adverse events will also be reported.The analysis will be undertaken separately in each sub-study,and then an overall analysis combining multiple subgroups will be performed to comprehensively investigate the effect of XFZY oral liquid.This study will provide high-quality evidence of XFZY oral liquid for QBP patients and show a paradigm of post-marketing evaluation of the effectiveness and safety for Chinese medicine following the notion of the pattern dominating different disease research models.

Abnormalities of masseter inhibitory reflex in patients with episodic tension-type headache

Objective： To investigate the masseter inhibitory tension-type headache （TTH）. Methods： MIR was studied in 21 sex matched to the study cohort. Median age of patients was reflex （MIR） and its eventual changes in patients with episodic patients with episodic TTH and 30 healthy subjects, with age and 17.0 years （ranged 16-49 years）, median duration of disease 12 months （1-5 years）, and median frequency of headache 7.5 d per month. Results： The second period of suppression （$2） of MIR was reduced in intensity and duration in 10% of controls and 66.7% （confidence interval （CI） 45.3%-85%; P〈0.05） of patients with episodic TTH （X2=74.9; P〈0.001）. In 3 （14.3%） of patients with episodic TTH, S2 was completely absent. No significant correlation between the duration of disease and headache frequency was found. Conclusion： Our results confirm the link between episodic TTH and reduction or absence of S2. Teenage patients with episodic TTH may exhibit marked pathological changes in S2 in contrast to older individuals.

Clinical Efficacy and Safety of Miniscalpel-Needle Treatment for Tension-Type Headache:A Systematic Review and Meta-Analysis

Objective:To investigate the clinical efficacy and safety of miniscalpel-needle(MSN)treatment for tension-type headache(TTH).Method:Seven medical databases were searched to identify randomized controlled trials(RCTs)evaluating the effect and safety of MSN treatment.All articles published up to November 15,2018 were retrieved.A meta-analysis was conducted for the included studies,and the risk of bias was assessed.Primary outcomes were visual analogue scale(VAS)or numeric rating scale(NRS)score.Secondary outcomes were clinical effective rates including total effective rate(TER),markedly effective rate(MER),and totally cured rate(TCR)determined by improvement in clinical symptoms or VAS scores,the frequency of adverse events(AEs)that occurred during the study,and participant quality of life(QOL).Results:Seven RCTs involving 724 participants were included.MSN treatment showed significantly higher MER and TCR[relative risk(RR)1.27,95%confidence interval(Cl)1.01 to 1.61;RR 1.31,95%Cl 1.09 to 1.57,respectively],but not TER(RR 1.03,95%Cl 0.96 to 1.10)compared to acupuncture.MSN treatment plus conventional treatment showed significant lower VAS and higher TER,MER,and TCR(mean difference-3.54,95%Cl-3.80 to-3.28;RR 1.14,95%Cl 1.06 to 1.23;RR 2.31,95%Cl 1.50 to 3.58;RR 3.01,95%Cl 2.25 to 4.02,respectively)compared to conventional treatment.Conclusions:According to current evidence,MSN treatment as a monotherapy or as an adjunctive treatment to other existing treatments might have benefits on treating TTH.However,since the number and the sample size of studies included were both small and the methodological quality was poor,the findings of this review should be interpreted with great caution,and our confidence in the results is low.A high quality RCT using objective outcomes should be performed on this topic.

Clinical study on acupuncture plus auricular point sticking for tension-type headache

Objective:To observe the clinical efficacy of acupuncture plus auricular point sticking for tension-type headache(TTH).Methods:A total of 90 TTH patients were divided into an acupuncture group,an auricular point sticking group and an observation group by random number table method,with 30 cases in each group.Patients in the observation group received acupuncture plus auricular point sticking for treatment,while those in the acupuncture group only received acupuncture and those in the auricular point sticking group only received auricular point sticking for treatment.The headache attack frequency and the scores of visual analog scale(VAS),self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were observed before treatment,after treatment and 3 months after treatment.The clinical efficacy was evaluated at the follow-up of 3 months after treatment.Results:At follow-up,there were significant differences in clinical efficacy among the three groups(P<0.01 or P<0.05),and the clinical efficacy ranking from high to low was the observation group,the acupuncture group and the auricular point sticking group.After treatment and at follow-up,the VAS score,headache attack frequency,SAS and SDS scores in the three groups were significantly lower than those before treatment(all P<0.01).The above four results in the observation group were lower than those in the acupuncture group and the auricular point sticking group at the same time point(all P<0.01);VAS score in the acupuncture group was lower than that in the auricular point sticking group(both P<0.05).At follow-up,the headache frequency in the acupuncture group was lower than that in the auricular point sticking group(P<0.05).Conclusion:Either using acupuncture and auricular point sticking together or separately can reduce the headache degree of TTH patients,reduce the number of headache attacks,and relieve anxiety and depression.The efficacy of acupuncture plus auricular point sticking is most significant.

Exploring cerebral structural and functional abnormalities in a mouse model of post-traumatic headache induced by mild traumatic brain injury

Mild traumatic brain injury(mTBI)-induced post-traumatic headache(PTH)is a pressing public health concern and leading cause of disability worldwide.Although PTH is often accompanied by neurological disorders,the exact underlying mechanism remains largely unknown.Identifying potential biomarkers may prompt the diagnosis and development of effective treatments for mTBI-induced PTH.In this study,a mouse model of mTBI-induced PTH was established to investigate its effects on cerebral structure and function during short-term recovery.Results indicated that mice with mTBI-induced PTH exhibited balance deficits during the early post-injury stage.Metabolic kinetics revealed that variations in neurotransmitters were most prominent in the cerebellum,temporal lobe/cortex,and hippocampal regions during the early stages of PTH.Additionally,variations in brain functional activities and connectivity were further detected in the early stage of PTH,particularly in the cerebellum and temporal cortex,suggesting that these regions play central roles in the mechanism underlying PTH.Moreover,our results suggested that GABA and glutamate may serve as potential diagnostic or prognostic biomarkers for PTH.Future studies should explore the specific neural circuits involved in the regulation of PTH by the cerebellum and temporal cortex,with these two regions potentially utilized as targets for non-invasive stimulation in future clinical treatment.

Clinical observation on electroacupuncture plus tuina for chronic tension-type headache

Objective：To observe the clinical efficacy of electroacupuncture （EA） combined with tuina for chronic tension-type headache （CTTH）. Methods：A total of 97 CTTH cases were randomly allocated into an observation group （n=52） and a control group （n=45）. Patients in the observation group were treated with EA plus tuina based on pattern identification, whereas patients in the control group were treated with oral amitriptyline and oryzanol. Patients in both groups were treated for 8 weeks. A follow-up was conducted 3 months after the treatment. The intensity, duration, and frequency of the headache were recorded and compared before and after the treatment. Additionally, the patients＇ psychological state and quality of life （QOL） were compared between the two groups. Results：There were intra-group statistically significant differences in headache intensity score, headache duration, and headache frequency after the treatment and during the follow-up compared with those before the treatment （allP〈0.05）; and there were between-group statistically significant differences during the same time frame （allP〈0.05）. The Hamilton depression scale-17 items （HAMD-17） and Hamilton anxiety scale （HAMA） scores were significantly reduced in both groups after the treatment or during the follow-up （allP〈0.01）; and there were no between-group statistical significances during the same time frame （allP〉0.05）. The World Health Organization quality of life-BREF （WHOQOL-BREF） scores were significantly reduced in both groups after the treatment or during the follow-up （allP〈0.05）; and the scores in the observation group were significantly lower than those in the control group （allP〈0.05） during the same time frame. The total effective rate was 88.0% in the observation group, versus 71.4% in the control group, showing a significant difference （P〈0.05）. Conclusion：EA combined with tuina can significantly decrease the frequency of chronic tension-type headache, alleviate headache intensity, shorten headache duration, and improve the patients＆#39; wellness. It is better than amitriptyline plus oryzanol.

Clinical Study of Tuina on Tension-type Headache with Syndrome Differentiation

The 6 point behavioral rating scale and Stead＇s grading method of diagnostic scale were applied to evaluate objectively the therapeutic effects of Tuina on 150 patients with tension-type headache in the experimental and controlled groups in this study. The results indicated that abdominal Tuina method of invigorating blood circulation and regulating qi had better effect than the routine Tuina method in treating tension-type headache. Meantime, it is considered that eliminating the immoderate defensive response caused by the process of headache-muscular contraction headache is the academic basis of the marked effect.

Retrospective Analysis of the Correlation between TMD, Headache and Bruxism

Aims: To evaluate the association between bruxism, headaches, and temporomandibular disorder (TMD). Methods: A keyword search of the clinical notes of patients’ charts in AxiUmTM was performed using the search terms “TMD”, “headache”, and “sleep bruxism” to identify these patients. The inclusion criteria were patients with partial of full dentition, aged 18 to 65 years old who attended the UNLV School of Dental Medicine clinics between January 2014 and September 2018. Patients with incomplete records and those who were completely edentulous formed the exclusion criteria. Data were analyzed using the Pearson Correlation Coefficient. Results: The final sample was made up of 529 patients. The highest percentage of study subjects were in the age range of 29 - 34 (17.9%), with a statistically significant correlation to pain on opening (P = 0.0403). Females showed a statistically significant correlation to TMJ clicking (P = 0.0033). Caucasians also had a statistically significant correlation to TMJ clicking (P = 0.0001). In addition, a statistically significant correlation between pain on opening or chewing and headaches was also observed (P = 0.0081). Conclusion: Within the limitations of the present study, Caucasians, and females presented with more TMJ clicking than the other study subjects. Young adults, in particular, experienced more pain on opening or chewing.

Ultrasound-Guided Greater Occipital Nerve Hydrodissection for Treatment of Cervicogenic Headache: A Case Report

We describe an innovative technique of ultrasound-guided greater occipital nerve (GON) hydrodissection for treatment of cervicogenic headache and occipital neuralgia. A 35-year-old female presented to the pain clinic with severe chronic cervicogenic headache impacting her sleep, work and activities of daily living. Conservative management had failed to adequately resolve her pain. Ultrasound-guided suboccipital hydrodissection of the greater occipital nerve was performed with the patient in the prone position. After skin sterilization, the linear ultrasound transducer was oriented in a transverse orientation at the level of the C2-C3 vertebrae. The needle was advanced from medial to lateral “in-plane” under direct ultrasound visualization, until the needle was positioned at the C2 lamina. After confirming the needle tip position, 10 ml of hydrodissection fluid was injected with good visualization of distribution of the solution. The patient described immediate and significant improvement in her symptoms. She reported a sustained decrease in pain scores when followed up in the pain clinic at six and twelve weeks respectively. To the best of our knowledge this is the first application of ultrasound-guided hydrodissection of the GON for cervicogenic headache. It offers a novel, safe and effective technique to aid in the diagnosis and treatment of a common pain condition.

Headaches and Erectile Dysfunction Medications at UTH-Kara (Togo)

Introduction: Headaches are a common symptom affecting individuals worldwide, including in the tropical zone, and have been extensively studied in Togo. Phosphodiesterase-5 inhibitors, commonly prescribed for erectile dysfunction, are known to induce headaches, yet there is a lack of research on this topic in sub-Saharan Africa and Togo. Methods: A cross-sectional study conducted from February 1st to June 30th, 2023, including adult patients seeking erectile dysfunction treatment and prescribed PDE-5 inhibitors. Results: A total of 28 patients were included in the study, with an average age of 34.46 ± 7.5 years. The age group of 30 - 39 years was the most represented (53.57%). Among the participants, 67.86% had a history of chronic headaches. During the intake of PDE-5 inhibitors, 71.43% reported the onset of headaches. Among the 19 patients with chronic headaches, 68.42% developed headaches following PDE-5 inhibitor use (RR = 0.88, 95% CI: 0.55 - 1.40, p = 0.484). The characteristics of the induced headaches were similar to the patients’ pre-existing headaches in 78.95% of cases. Additional symptoms included nasal congestion (36.84%) and an urge to have a bowel movement (26.32%). Sildenafil (75.00%) and Tadalafil (25.00%) were the primarily prescribed PDE-5 inhibitors. The incidence of headaches did not significantly differ between the two groups (RR = 1.33, 95% CI: 0.67 - 2.64, p = 0.306). Treatment for the induced headaches involved self-medication with paracetamol (65.00%) and nonsteroidal anti-inflammatory drugs (NSAIDs) (35.00%). Conclusion: Headaches induced by PDE-5 inhibitors are a well-established reality, emphasizing the need for caution and warning in patients with pre-existing headache conditions, while individualized approaches are necessary to address the potential interplay between migraine medications and erectile dysfunction treatments.

Mechanism of Scalp Acupuncture Combined with Distal Acupoint Selection in the Treatment of Vascular Headache Caused by Hyperactivity of Liver-Yang

The clinical effect of acupuncture on vascular headache caused by hyperactivity of liver-yang has been shown, but the specific mechanism is not yet clear. This paper is intended to discuss the etiology and pathogenesis of vascular headache caused by hyperactivity of liver-yang and the mechanism of acupuncture, so as to provide a certain reference for clinical diagnosis and treatment of scalp acupuncture treatment of vascular headache caused by hyperactivity of liver-yang.

Myeloperoxidase-antineutrophil cytoplasmic antibody-associated vasculitis with headache and kidney involvement at presentation and with arthralgia at relapse:A case report

BACKGROUND Patients with proteinase 3-antineutrophil cytoplasmic antibody associated vasculitis(AAV)experience different manifestations at the initial onset and relapse.However,such cases of different initial and relapse manifestations have not been reported in myeloperoxidase(MPO)-AAV patients.CASE SUMMARY A 52-year-old woman was admitted to our hospital because of headache.Laboratory findings indicated nephrotic range proteinuria and microscopic hematuria,serum creatinine of 243μmol/L,anti-MPO antibody titer of>400 RU/mL,and positive perinuclearantineutrophil cytoplasmic antibody.Renal biopsy showed pauci-immune crescentic glomerulonephritis.The cerebrospinal fluid examination and brain magnetic resonance imaging did not show any abnormality.Therefore,MPO-AAV was diagnosed.Corticosteroids,plasmapheresis,and cyclophosphamide as induction therapy and mycophenolate mofetil(MMF)as maintenance therapy were administered.The patient’s headache disappeared;serum creatinine returned to normal;complete remission of microscopic hematuria and proteinuria was observed.Anti-MPO antibody titer reached normal limits after immunosuppressive treatment.Twenty-five months after stopping the immunosuppressive treatment,the patient relapsed with arthralgia,without neurological or renal involvement.The patient’s arthralgia improved after treatment with prednisone and MMF.CONCLUSION We have reported a rare case of MPO-AAV who initially presented with headache and kidney involvement.However,relapse presented with only arthralgia,which was completely different from the initial manifestations.This case suggests that AAV relapse should be highly suspected in MPO-AAV patients after remission,when clinical manifestations at relapse are different from those at onset.Prednisone and MMF may provide a good choice for refractory arthralgia during relapse in MPO-AAV patients.

Exploring the mechanism of action of Wuzhuyu Decoction for vascular headache based on network pharmacology and molecular docking

Background:The aim of this study is to explore the mechanism by which Wuzhuyu Decoction treats vascular headache.Methods:We utilized the TCMSP database to identify active ingredients and targets of the Chinese herbal medicine,and the Gendcars,OMIM,PharmGKB,TTD,and DrugBank databases were used to screen for disease targets.We constructed the PPI network of targets by utilizing the String database,and GO and KEGG analyses were performed.The"drug-ingredient-target-disease"network diagram was constructed using Cytoscape 3.8.0 software.We analyzed the topological parameters to identify the primary active ingredients and targets of Wuzhuyu Decoction,and subsequently confirmed the findings via molecular docking.Results:A total of 86 active ingredients were obtained,including Quercetin,Kaempferol,Beta-sitosterol,Stigmasterol,and Nuciferin.Fourteen core targets were identified,including JUN,TP53,AKT1,RELA,MAPK1,MAPK14,MYC,MAPK8,CCND1,ESR1,CTNNB1,FOS,NR3C1,and RB1.GO enrichment analysis involved biological processes such as response to drug,response to lipopolysaccharide,and response to molecule of bacterial origin.The cellular components were membrane raft and membrane microdomain,and the molecular functions were catecholamine binding and nuclear receptor activity.The KEGG pathway enrichment analysis demonstrated the potential regulation of 171 pathways by Wuzhuyu Decoction.including the Lipid and atherosclerosis signaling pathway,the Fluid shear stress and atherosclerosis signaling pathway,and the PI3K-AKT signaling pathway.Molecular docking showed that Nuciferin had good binding activity with AKT1(-9.9 kJ/mol),as did Quercetin with AKT1(-9.8 kJ/mol),Stigmasterol with MAPK1(-9.7 kJ/mol),and Kaempferol with AKT1(-9.5 kJ/mol).Conclusion:Wuzhuyu Decoction may exert its therapeutic effect on vascular headache by inhibiting neurogenic inflammation,providing analgesia,and modulating the immune system.

Effects of Toutongning capsule on enkephalin expression in a rat migraine headache model

Toutongning capsule is used for the treatment of migraine headaches, and has yielded therapeutically beneficial effects. However, whether Toutongning capsule exerts its effects via endogenous opioid peptides remains poorly understood. This study investigated the effects of Toutongning capsule on enkephalin expression in the midbrain of rats with nitroglycerin-induced migraine headache at the mRNA and protein levels. Results confirmed that proenkephalin mRNA levels were significantly upregulated following treatment with Toutongning capsule. The numbers methionine-enkephalin and leucine-enkephalin-positive cells were significantly greater in the migraine headache rats following treatment with Toutongning capsule compared with the model group. Taken together, these results show that Toutongning capsule exerts potentially beneficial effects by promoting enkephalin expression in nitroglycerin-induced migraine headache rats.

Mild closed head traumatic brain injury-induced changes in monoamine neurotransmitters in the trigeminal subnuclei of a rat model:mechanisms underlying orofacial allodynias and headache

Our recent findings have demonstrated that rodent models of closed head traumatic brain injury exhibit comprehensive evidence of progressive and enduring orofacial allodynias, a hypersensitive pain response induced by non-painful stimulation. These allodynias, tested using thermal hyperalgesia, correlated with changes in several known pain signaling receptors and molecules along the trigeminal pain pathway, especially in the trigeminal nucleus caudalis. This study focused to extend our previous work to investigate the changes in monoamine neurotransmitter immunoreactivity changes in spinal trigeminal nucleus oralis, pars interpolaris and nucleus tractus solitaries following mild to moderate closed head traumatic brain injury, which are related to tactile allodynia, touch-pressure sensitivity, and visceral pain. Our results exhibited significant alterations in the excitatory monoamine, serotonin, in spinal trigeminal nucleus oralis and pars interpolaris which usually modulate tactile and mechanical sensitivity in addition to the thermal sensitivity. Moreover, we also detected a robust alteration in the expression of serotonin, and inhibitory molecule norepinephrine in the nucleus tractus solitaries, which might indicate the possibility of an alteration in visceral pain, and existence of other morbidities related to solitary nucleus dysfunction in this rodent model of mild to moderate closed head traumatic brain injury. Collectively, widespread changes in monoamine neurotransmitter may be related to orofacial allodynhias and headache after traumatic brain injury.

Recurrent headaches may be caused by cerebral toxoplasmosis

AIM: To establish seroprevalence and provide characteristics of Toxoplasma gondii(TG) infection in children with recurrent headaches. METHODS: The study was performed in 178 children aged 7-17 years admitted consecutively to the Department of Pediatric Neurology from November 2009 to July 2011. The children were surveyed with a questionnaire with the help and assistance of their parents and blood samples taken on admission were studied for the presence of specific anti-TG Ig M, Ig G antibodies and Ig G avidity using enzyme immunoassay Platelia Toxo Ig M, Ig G. RESULTS: The study showed that 19 children(8 boys, 11 girls; 8-17 years old, mean age 14.36 years) hadhigh serum anti-TG Ig G antibody levels(range: 32.2 > 240 UI/m L, mean 120.18 UI/m L; positive value for Ig G was ≥ 9 UI/m L). The avidity index(AI) ranged from 0.202 to 0.925(scale: ≥ 0.5 high AI). The results for Ig M antibodies were all negative and the obtained results ranged from 0.113 to 0.25 U/m L(mean = 0.191 IU/m L) and all values below 0.8 IU/m L were considered negative. The most frequent complaints found in the seropositive patients were headaches that affected the frontal(13 children), occipital(4) and parietal areas(5). Headaches usually had a pulsating(in 7 patients) and squeezing(6) character and rarely were piercing, dull or expanding. Interestingly, 8 children did not feel discomfort during the headaches, probably because they did not have sufficiently increased intracranial pressure yet. The headaches usually appeared 1-2 times/mo, lasted for 2-6 h, and had a mean intensity of 5.5 points in a 10 point subjective scale. The comorbidities included epilepsy(5 patients), various infections in 3 children(chronic eustachitis, chronic rhinitis, chronic purulent tonsillitis, streptococcal pharyngitis, meningitis, allergic diseases), disturbances of behavior, deficits of attention, and ocular and motor concentration disorders in 1 child. The electroencephalographic and neuroimaging studies performed in our patients had a very limited value in establishing cerebral toxoplasmosis.CONCLUSION: Ten point six seven percent of the studied children had markedly increased serum anti-TG Ig G antibodies and high AI indicated chronic infestation. It is suggested that tests for TG infection should be introduced to routine diagnostics in patients with recurrent headaches.

Headache:An unusual presentation of acute myocardial infraction

Acute myocardial infarction should be diagnosed as early as possible for the appropriate management to salvage ischemic myocardium. Accurate diagnosis is typically based on the typical symptoms of angina. Headache is an unusual symptom in patients with acute myocardial infraction. We report a patient with ST-segment elevation acute myocardial infarction who presented to the emergency department complaining of severe occipital headache without chest discomfort.