Background: A wide range of preventive medications for migraine attacks, with varying efficacy is currently in use. Studies comparing the efficacies of these drugs would be of value in the proper treatment of the disease. The present study compared the frequency, duration and intensity of migraine attacks during and following treatment with cyproheptadine (4 mg, twice daily) or Blellergal (belladonna 0.1 mg, ergotamine 0.3 mg and phenobarbital 20 mg). Methods: 118 patients 15 to 45 year-old with migraine HEADACHEs were randomly allocated to groups I (n=36), II (n=40) and III (n=42) and treated during three consecutive phases of 45 days. In phase one all groups received two oral placebo tablets daily. In phase two, group I continued with placebo, groups II and III received cyproheptadine (4 mg, twice daily) and Bellergal (three tablets daily), and finally, in phase three all groups were treated with placebo, respectively. Results: Cyproheptadine and Bellergal treatments significantly reduced the frequency, duration and intensity of migraine attacks. These parameters remained low during phase three (placebo) in cyproheptadine treated patients as compared to those who only received placebo. But there was a rebound effect following discontinuation of Bellergal. Conclusion: Cyproheptadine and Bellergal seem to preventive migraine attacks. Cyproheptadine is a preferred choice because its effects were partially preserved following withdrawal.

Background and Aim: Migraine is the most common primary HEADACHE syndrome with no specific pathologic reason affecting physical, mental and social aspects of quality of life and reduces health-related quality of life (HRQOL). Migraine is the most noticeable medical issue in women's health, since it is more prevalent among them during the reproductive years between the ages of 25 and 55 years. The low frequency of organic causes for and the increasing prevalence of HEADACHE suggest individual and environmental factors. The aim of this study is to investigate the associations between migraine HEADACHE and lifestyle in women. Material and Method: This is a case-control study on 170 subjects aged 18-50 years randomly selected by Poisson sampling from population of women with HEADACHE referring to neurology clinics of Al-zahra and Nour hospitals affiliated to Isfahan University of Medical Sciences with an absolute diagnosis of migraine by neurologist based on the criteria of the International HEADACHE Society .The control group comprised of all women with no migraine having identical inclusion criteria with the study subjects. The data were collected by interviews with a researcher designed questionnaire. The questionnaire was used after the scientific validity and reliability had been confirmed by content validity and Test-retest, respectively. Descriptive and analytical statistical tests (independent t test, Chi-square test and Fisher exact test) were used to analyze the data. Results: The findings showed that there was a statistically significant association between some dimensions of lifestyle such as nutrition status and food habits (P£0.001), sleep and rest pattern (P 0.012), medication habit pattern (P£0.001) with migraine. Meanwhile, there was no statistically significant association between smoking, physical activity and sport pattern and the level of exposure to life stressors with moraine. The result of the study is in line with some findings of other investigations suggesting that some lifestyle factors probably play a role as migraine precipitating factor.Conclusion: According to the results, for preventing of the attack onset and minimizing side effects of drug abuse, it's necessary to pay more attention to the importance of change and modification of lifestyle in migraine patients and to consider the assessment of lifestyle and health behavior as priorities of health care.

Pompe disease, also termed glycogen storage disease type II or acid maltase deficiency, caused by deficient activity of acid alpha-glucosidase (GAA), the glycogen degrading lysosomal enzyme. As a result, massive lysosomal glycogen deposits in the numerous organs including the muscles. In Pompe disease weakness of truncal muscles is a prominent presentation which results in respiratory failure as a main clinical presentation in the early stages of the disease. Even sleep may be affected by nocturnal respiratory disturbances. Specific treatment with enzyme replacement (human recombinant GAA) is available. Here we present a case of progressive muscular weakness which had been misdiagnosed with limb girdle muscular dystrophy. A history of severe morning HEADACHEs led authors to think about sleep apnea, which was confirmed by polysomnography and therefore provided a clue for appropriate diagnosis of Pompe disease. As a conclusion, Morning HEADACHEs and sleep insufficiency in any stage of a progressive muscular disorder can lead us to think about respiratory muscle involvement, which is more prominent in Pompe disease.

The electrocardiogram (ECG) discussed in this article is related to a 26-year-old man with chief complaint of HEADACHE accompanied with nausea and diplopia. The ECG discussed in the present article is shown in figure 1. What is the correct interpretation of this ECG...

Context: Neuromodulation is an expanding fi eld of study for HEADACHE treatment to reduce pain by targeting structures within the nervous system that are commonly involved in HEADACHE pathophysiology, such as the vagus nerve (VNS), occipital nerves, or sphenopalatine ganglion (SPG) for stimulation. Pharmaceutical medical therapies for abortive and prophylactic treatment, such as triptans, NSAIDs, beta-blockers, TCAs, and antiepileptics, are eff ective for some individuals, but the role that technology plays in investigating other therapeutic modalities is essential. Peripheral neuromodulation has gained popularity and FDA approval for use in treating certain HEADACHEs and migraine HEADACHE conditions, particularly in those who are refractory to treatment. Early trials found FDA approved neurostimulatory implant devices, including Cephaly and SpringTMS, improved patient-oriented outcomes with reductions in HEADACHEs per month (frequency) and severity. Evidence Acquisition: This was a narrative review. The sources for this review are as follows: Searching on PubMed, Google Scholar, Medline, and ScienceDirect from 1990-2019 using keywords: Peripheral Neuromodulation, HEADACHE, vagus nerve, occipital nerves, sphenopalatine ganglion. Results: The fi rst noninvasive neurostimulator device approved for migraine treatment was the Cefaly device, an external trigeminal nerve stimulation device (e-TNS) that transcutaneously excites the supratrochlear and supraorbital branches of the ophthalmic nerve. The second noninvasive neurostimulation device receiving FDA approval was the single-pulse transcranial magnetic stimulator, SpringTMS, positioned at the occiput to treat migraine with aura. GammaCore is a handheld transcutaneous vagal nerve stimulator applied directly to the neck at home by the patient for treatment of cluster HEADACHE (CH) and migraine. Several other devices are in development for the treatment of HEADACHEs and target HEADACHE evolution at diff erent levels and inputs. The Scion device is a caloric vestibular stimulator (CVS) which interfaces with the user through a set of small cones resting in the ear canal on either side and held in place by modifi ed over-ear headphones. The pulsante SPG Microstimulator is a patient-controlled device implanted in the patient’ s upper jaw via an hour-long oral procedure to target the sphenopalatine ganglion. The occipital nerve stimulator (ONS) is an invasive neuromodulation device for HEADACHE treatment that consists of an implanted pulse generator on the chest wall connected to a subcutaneous lead with 4-8 electrodes that is tunneled the occiput. Conclusions: The aim of this review is to provide a comprehensive overview of the effi cacy, preliminary outcomes, and limitations of neurostimulatory implants available for use in the US and those pending further development.

Background: The correlation of metabolic syndrome and migraine HEADACHE was evaluated in some previous studies. However there is no study that compared the prevalence of metabolic syndrome in the patients with and without migraine. Control of coincidental factors such as metabolic syndrome reduces therapeutic resistance in migrainous patients. The aim of this study was to compare prevalence of metabolic syndrome in patients with and without migraine HEADACHE.Materials and Methods: 200 migrainous patients diagnosed according to International HEADACHE Society and 200 healthy controls without migraine enrolled in this study. Metabolic syndrome was diagnosed according to ATP III criteria in these two groups and compared with each other.Results: In this study, 17% (34) of migrainous patients and 15% (30) of healthy control without migraine had metabolic syndrome. (P=0.585). Of the metabolic syndrome components, body mass index (P=0.05) and waist circumference in migrainous (P=0.03) were significantly more frequent.Conclusion: Our results demonstrate that metabolic syndrome and migraine HEADACHE had not significant correlation, however, higher body mass index and waist circumference as metabolic syndrome components had correlated with migraine HEADACHE.

Introduction: Tension HEADACHE is the most common type of HEADACHE. Tension HEADACHE is mostly caused by stress, anxiety and depression. Treatment is by pharmacological and nonpharmacological methods. Nowadays nonpharmacological methods are used increasingly. This is a response to the over use of drugs, side effects and cost. The purpose of this study was to evaluate the effectiveness of a nonpharmacological method in treatment of chronic tension HEADACHE. Materials and methods: This research is a clinical trial study. 25 women suffered from chronic tension HEADACHE were treated by massage during 5 weeks. Samples were asked to record. HEADACHE indexes in a checklist four times a day (before breakfast, before launch, before dinner and before sleep) through these 5 weeks. Data from the first and fifth weeks were recorded as pre and post intervention data and data from the second, third and fourth weeks of investigation were recorded as the data during intervention. During the intervention samples were treated twice a week for 20 minutes each time with the friction massage on posterior parts of the neck and shoulders. HEADACHE indexes included: intensity, frequency and duration of HEADACHE. HEADACHE intensity was recorded using 11 points criteria. HEADACHE frequency was measured by calculating the days of HEADACHE in a week and the duration of the HEADACHE was calculated by dividing sum of HEADACHE hours in a week to the frequency of attacks. Data was analyzed by analysis of variances and Tukey test. Results: Results showed the positive effect of massage in which HEADACHE indexes showed a meaningful difference in three stages of pre, during and post intervention (P<0.01). The recovery rates for each index were 52%, 28% and 57% respectively. Conclusion: Massage therapy resulted in the reduction of intensity, frequency and duration of tension HEADACHE and can be useful in treatment of tension HEADACHE.    

Although recent studies have focused on finding the major molecule involved in migraine, but its exact molecular mechanism has not been clarified yet. Based on human HEADACHE models (GTN and Histamine), it has been proposed that histamine may play a role through affecting cerebral endothelial H1- receptors followed by NO release. In addition, there are more recent studies showing that migraine is due to histamine release from mast cells, which are often in close vicinity of neurons where they are activated by neuropeptides and in response release nitric oxide. Since there was no report on parallel alteration of histamine and nitric oxide in biological fluids of migraine sufferers, therefore we decided to determine the role of histamine in migraine-associated pain (lonely or via NO). For this purpose, we measured serum histamine level by an improved fluorometric method and serum NO level by Griess method in pain and no-pain phases of migraine attack. These results showed that there is a significant increase in serum histamine level in pain and no-pain stages of patients compared with control group and in contrast, serum NO level in migraine sufferers was significantly reduced. These findings may indicate the involvement of these molecules in migraine pain. In addition, data analysis showed that serum NO level of those patients with a higher serum histamine level is significantly lower. Thus some kind of relationship exists between these two molecules.