Background:Migraine is a significant cause of disability, especially in women and adults aged 25-55 years. Biobehavioral techniques provide nonpharmacologic strategies that circumvent the undesirable effects of medications. The acceptance of pain is becoming recognized in migraine management, yet headache-specific assessments remain limited. The Headache Acceptance Questionnaire (HAQ) addresses this gap as a headache-specific measure of pain acceptance. Following translation and cultural adaptation, we evaluated the correlation between HAQ scores and migraine-related impairment.Methods:In a cross-sectional cohort from a tertiary clinic (February to December 2024), the six-item HAQ was translated and adapted per standard guidance. We included 184 patients with migraine (156 women). Correlations tested associations between HAQ and disability indices, specifically the Headache Impact Test-6 (HIT-6), and the Migraine Disability Assessment Scale (MIDAS).Results:The Turkish HAQ demonstrated excellent content and structural validity (Kaiser-Meyer-Olkin = 0.89; Bartlett P < 0.001). A good fit was achieved on two-factor structure on factor analyses. Reliability was high (Cronbach's alpha = 0.91; intraclass correlation coefficient = 0.99). HAQ scores showed strong inverse correlations with MIDAS (r = -0.73, P < 0.001) and HIT-6 (r = -0.86, P < 0.001), indicating that greater acceptance corresponded with lower disability.Conclusions:The Turkish HAQ is a valid, reliable instrument for headache-specific acceptance. Higher acceptance aligns with less migraine-related disability, underscoring clinical utility and the relevance of acceptance-based therapies.
Introduction:Studies investigating the relationship between migraine and craniovertebral junction (CVJ) morphometric features in children are limited. In this study, we investigated morphologic changes in CVJ angles and the co-relationship between the presence of cerebellar tonsil ectopia (CTE) and clinical characteristics (frequency, severity) in the pediatric population with a diagnosis of migraine.Methods:Data from 101 pediatric participants were compared (30 with episodic migraine [EM], 33 with chronic migraine [CM], and 38 healthy participants). Magnetic resonance imaging of the participants was analyzed, and clivus canal angle (CCA), cranio-cervical tilt angle (CCT), Boogard angle (BA), Welcher basal angle (WBA), and Basion-opistion McRae line length were measured. The presence of CTE was recorded. Participants in the CM group were administered a Visual Analog Scale to assess the severity of pain and the Headache Impact Test-6 (HIT-6) to assess the level of its effect.Results:The measured angles (CCA, CCT, BA, WBA, and MCL) were not statistically different in any of the three groups (P > 0.05). CTE incidence in the EM group was found to be significantly higher compared with the CM and control groups (P = 0.001). Female participants had significantly higher HIT-6 scores than male participants (P = 0.033).Conclusion:This study suggests that parameters such as severity of headache, triggers, and disabling effects should be taken into consideration when distinguishing between EM and CM in children. Supporting the diagnostic process with objective data will be beneficial in terms of correctly distinguishing clinical subtypes and choosing appropriate treatment options (such as neuromodulation).
Objective:Video-EEG monitoring (VEM) can be classified into short-term and long-term monitoring. Short-term VEM (S-VEM) may fail to capture ictal activity, thereby restricting the ictal EEG findings necessary for the localization of the seizure onset zone in focal epilepsy syndromes. We retrospectively analyzed focal epilepsy patients whose seizures occurred only during sleep on VEM.Materials and Methods:Patients monitored between 2005 and 2023 at our VEM unit with seizures exclusively during sleep were reviewed. Patients were classified into temporal and extratemporal lobe epilepsy (ETLE) groups, and seizure timing was analyzed in relation to working (08:00-17:00) and non-working hours (17:00-08:00). Age, duration of hospital stay, admission-to-seizure interval, seizure frequency, and magnetic resonance imaging findings were compared.Results:Among 1961 VEM patients, 178 fulfilled the inclusion criteria, including 106 with TLE and 61 with ETLE. The most common pathology was hippocampal sclerosis (50%). Sleep-related hypermotor epilepsy (SRHE) was observed in 47 patients: 42 ETLE, 4 TLE, and 1 unlocalized. Most seizures occurred outside working hours, with TLE patients more likely to have non-working hour seizures, while ETLE patients showed higher seizure frequency and clustering. Besides that, fewer recorded seizures, TLE patients had longer hospital stays and admission-to-seizure intervals.Conclusion:In focal epilepsy patients with seizures exclusively during sleep, TLE was the most common type, and hippocampal sclerosis was the most frequent pathology, while SRHE was more prevalent in ETLE. S-VEM had a limited diagnostic yield in both groups, highlighting the need for alternative or prolonged monitoring adapted to seizure timing and epilepsy subtype.
Background: Thymectomy is an established therapeutic approach in myasthenia gravis (MG) and provides clinical benefit in selected patient populations. Nevertheless, long-term outcomes remain variable among patients with acetylcholine receptor (AChR) antibody positivity, irrespective of thymoma status. Objective: To assess postthymectomy clinical outcomes and determine prognostic factors associated with relapse in patients with AChR antibody-positive MG. Methods: A retrospective analysis was performed on 41 adult patients with AChR antibody-positive MG who underwent video-assisted thoracoscopic thymectomy between 2012 and 2024. All patients had received immunomodulatory treatment for at least 6 months before surgery. Disease severity was evaluated using MG composite (MGC) scores and MG foundation of America (MGFA) clinical classification at baseline, at 1 year postoperatively, and at the final follow-up visit. Clinical outcomes were classified as complete stable remission (CSR), pharmacologic remission (PR), or exacerbation. Results: At the final follow-up, CSR was achieved in 17.1% of patients, 41.5% were in PR, and 41.5% experienced disease exacerbation. MGC scores showed a significant reduction at the 1-year follow-up compared with baseline (P < 0.001). Poor clinical outcomes were significantly associated with higher baseline MGC scores and more advanced MGFA stages (P = 0.026 and P = 0.03, respectively). Receiver operating characteristic analysis demonstrated that a baseline MGC score of 12.5 or higher was a moderate predictor of poor clinical outcome (P = 0.013). Conclusion: Thymectomy was associated with meaningful clinical improvement in patients with AChR antibody-positive MG, particularly during the first postoperative year. An elevated baseline MGC score (>12.5) was independently associated with an increased likelihood of poor clinical prognosis.
