BACKGROUND:Numerous studies have evaluated greater occipital nerve (GON) blockade for migraine prophylaxis using various techniques and anesthetic agents, yet a standardized protocol remains lacking. Although both lidocaine and bupivacaine are effective compared with placebo, no direct comparison exists. This study aimed to compare the efficacy of lidocaine and bupivacaine in GON blockade for chronic migraine. MATERIALS AND METHODS:Data from 79 chronic migraine patients who underwent ultrasound-guided GON blockade at the University of Health Sciences Ankara Training and Research Hospital were retrospectively analyzed. Patients received either 1.5 mL of 2% lidocaine + 1 mL saline or 1.5 mL of 0.5% bupivacaine + 1 mL saline. Multivariate path analysis was used to evaluate the factors affecting pain reduction and to adjust for baseline differences. Blocks were administered weekly during the first month and monthly for two subsequent months on the side corresponding to pain. The number of headache days, attack duration, and Visual Analog Scale (VAS) scores were recorded before and after each session. RESULTS:Both groups showed significant reductions in headache days, attack duration, and VAS scores after treatment. Baseline values were similar except for disease duration, which was significantly longer in the bupivacaine group (p = 0.028). At the first month, the bupivacaine group reported significantly more headache days than the lidocaine group (P = 0.046), but no further intergroup differences were found. Although the lidocaine group showed lower pain scores in the first month in univariate analysis, multivariate path analysis revealed that the treatment group (Lidocaine vs. Bupivacaine) did not have a statistically significant effect on the change in VAS scores (p > 0.05). The baseline VAS score was the only significant predictor of pain reduction (β = -0.70, p < 0.001). CONCLUSION:Lidocaine and bupivacaine were both effective for migraine prophylaxis via GON blockade. While lidocaine appeared to provide faster relief initially, regression analysis suggests that baseline pain severity, rather than the choice of agent or disease duration, is the primary determinant of treatment response.

Background: Idiopathic intracranial hypertension without papilledema (IIHWOP) is increasingly recognized, but its clinical characteristics and treatment-related outcomes remain insufficiently defined. This study aimed to compare patients with idiopathic intracranial hypertension (IIH) with and without papilledema. Methods: This retrospective observational cohort study included adult patients diagnosed with IIH at a tertiary neurology and referral center. Demographic, clinical, neuro-ophthalmologic, radiological, lumbar puncture, and treatment-related characteristics were compared according to papilledema status. Results: Among 123 patients with IIH, 83 (67.5%) had papilledema, and 40 (32.5%) had IIHWOP. Age, sex distribution, body mass index, lumbar puncture opening pressure, and most neuroimaging findings were similar between groups. In exploratory between-group analyses, photophobia [35/40 (87.5%) vs. 55/83 (66.3%), p = 0.023], phonophobia [35/40 (87.5%) vs. 56/83 (67.5%), p = 0.031], and nausea/vomiting [20/40 (50.0%) vs. 17/83 (20.5%), p = 0.002] were more frequent among patients with IIHWOP than among those with papilledema. Diabetes mellitus was also more frequent in the IIHWOP group [8/40 (20.0%) vs. 5/83 (6.0%), p = 0.040]. Treatment persistence did not differ significantly between groups (log-rank p = 0.604). In multivariable analysis, papilledema was associated with higher odds of failure to achieve a complete treatment response, whereas higher lumbar puncture opening pressure was associated with lower odds of treatment nonresponse. Conclusions: Exploratory analyses suggested that patients with IIHWOP may exhibit a different clinical presentation characterized by more prominent migraine-like symptoms. However, these exploratory observations require confirmation in prospective studies.

Background:Medication overuse headache (MOH) is a chronic headache (CH) that develops or worsens due to medication overuse. Somatization and hypochondriasis, as well as beliefs about the experienced pain, may accompany many chronic pain situations from a holistic perspective. Objective:This study aimed to compare MOH patients with CH and episodic headache (EH) in terms of somatization, hypochondriasis, and beliefs and attitudes on pain. Methods:The Hospital Depression and Anxiety Scale (HADS), the Somatosensory Amplification Scale (SSAS), the Pain Beliefs Questionnaire (PBQ), the Pain Catastrophizing Scale (PCS), Eysenck Personality Questionnaire Revised-Short Form (EPQR-S), and Whiteley index-7 (WI-7) were administered to the participants with MOH (n = 80), CH (n = 81), and EH (n = 79). Results:There were no group differences in terms of somatic amplification between MOH and CH group. A high WI_Total score (lower hypochondriacal tendency) was predictive in separating the MOH group from the CH one. The score obtained from the PBQ_Organic subscale in the MOH group was significantly lower than the EH group, while the PCS_Total, PCS_Helplessness, PCS_Rumination, and HADS scores were significantly higher (p < 0.05). Conclusion:Our results indicate that the patients in the MOH group had more organic pain beliefs, felt more helpless in case of pain, and experienced exaggeration and rumination more than the EH group, while hypochondriasis was lower than in the CH group. This could indicate that patients with MOH do not seek further treatment that can lead to more headache medication use without medical examination.

OBJECTIVES:Migraine is a common cause of headache and a leading cause of morbidity in Türkiye. This study aimed to describe the clinical characteristics and management of migraine and to compare migraine with tension-type headache (TTH) regarding the burden of disease and healthcare resource utilization. METHODS:A total of 1368 patients (aged 18-65 years) with migraine or TTH were surveyed regarding sociodemographics, headache characteristics, clinical management, disease burden, quality of life, and healthcare resource utilization within the previous 12 months. Data from 1053 patients meeting the criteria for definite migraine (dMIG) or definite TTH (dTTH) were analyzed. RESULTS:The frequency and duration of attacks, the number of monthly headache days, days with analgesic consumption, and headache severity were significantly higher in dMIG compared to dTTH. Only 36.8% of definite migraineurs experiencing ≥4 monthly headache days were on preventive treatment. The negative impact on quality of life and economic loss were also higher in dMIG. Although more patients with dTTH visited a physician in the previous year, the number of physician visits was higher in dMIG. The groups were comparable regarding the percentage of patients who underwent radiological investigations due to headache; however, patients with dMIG had more brain magnetic resonance imaging and computed tomography scans. CONCLUSION:Timely and accurate diagnosis and optimal management of migraine are crucial due to its significant burden. Educational programs for patients and healthcare providers, along with adherence to and persistence with preventive medications, may improve clinical outcomes.

IntroductionMigraine, characterized by recurrent attacks, often necessitates a holistic approach for effective management. Treatment strategies aimed at enhancing self-esteem and self-compassion have been shown to reduce pain intensity in patients with chronic pain. This study aimed to investigate self-esteem and self-compassion in individuals with migraine.Materials and methodsThis multicentre, cross-sectional, case–control study included migraine patients evaluated at headache-specialized outpatient clinics across 22 centers in different regions of Turkey. 901 migraine patients and 901 healthy, matched controls were included. Neurologists specializing in headache disorders administered the Rosenberg Self-Esteem Scale, Self-Compassion Scale, Beck Depression Inventory, and Beck Anxiety Inventory to all participants. Data were compiled at a central site and subjected to statistical analysis.ResultsMigraine patients exhibited significantly lower self-esteem scores compared to healthy controls (p = 0.001 for both). Additionally, Beck Depression Inventory and Beck Anxiety Inventory scores were significantly higher in migraine patients (p = 0.001 for both). Although the mean self-compassion scores of migraine patients and healthy controls were comparable, a significant decline in self-compassion was observed among patients with higher migraine attack frequency.DiscussionIn conclusion, our findings indicate that migraine patients exhibit significantly higher levels of anxiety and depression compared to healthy controls. Self-esteem scores were also found to be lower in the migraine group. Although self-compassion scores were similar between the two groups, a noteworthy decline in self-compassion was observed in patients with higher migraine attack frequency. These results suggest that increased migraine severity may negatively impact patients’ emotional resilience, highlighting the potential value of integrating psychological support into migraine management, particularly for those with frequent attacks.

Objectives:The aim of this study was to evaluate the results of the construct validity of the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Multiple Sclerosis (MS) and to identify the impact of MS on specific health domains according to the ICF categories in Turkish individuals.Patients and methods:Between December 2011 and December 2012, a total of 150 individuals with MS (69 males, 81 females; mean age: 39.8±8.0 years; range, 19 to 52 years) who were diagnosed by a neurologist at least six months previously were included. The Comprehensive ICF Core Set for MS was used to assess functioning, disability, and environmental factors in all participants. The Spearman correlation coefficient was used to determine construct validity of the ICF Core Set between the ICF components and disease-specific and general measurements.Results:The most frequently coded impairments in the body functions component were b280 sensation of pain, b134 sleep functions, b1301 motivations, and b740 muscle endurance functions. The most frequently coded impairments in the body structures component were s110 structure of brain, s120 spinal cord and related structures and s750 structure of lower extremity. A significant problem was documented in 47 of the 53 categories of the activities and participation. Of the 38 categories in the environmental factors, 23 were identified as a facilitator, while 12 categories were identified as a barrier. All body function, structure, activities and participation and environmental factors categories showed a significant correlation with disease-specific and generic measures.Conclusion:Based on these results, the ICF Core Set may help to determine major facilitators or barriers to functioning and disability and a targeted rehabilitation approach in patients with MS.

Ocular complications are one of the rare side effects that can be seen after a mandibular nerve block and have the most dramatic results. Since the mandibular nerve block is mostly performed by dentists, this complication is mostly seen after an intraoral mandibular nerve block. The mandibular nerve is the third division of the trigeminal nerve. It is the most caudal and lateral part of Gasser's ganglion. It arises from the middle cranial fossa through the foramen ovale. In this region, a block method, which is performed by passing through the coronoid process, has been defined. This block, usually made using anatomical markers, is used in the treatment of trigeminal neuralgia. A 42-year-old female patient was admitted to our department for a maxillary and mandibular block with a diagnosis of trigeminal neuralgia. Immediately after the administration of the local anesthetic, the patient described a complete loss of vision. The complaint of vision loss lasted for about 1 minute, after which the patient's complaint of diplopia continued for 2 hours and 10 minutes. This case report presents the ocular complications after a mandibular block applied with the extraoral technique as an unexpected side effect.

Abstract Background Migraine is a disease characterized by headache attacks. The disease is multifactorial in etiology and genetic and environmental factors play role in pathogenesis. Migraine can also be accompanied by psychiatric disorders like neurotism and obsessive compulsive disorder. Stress, hormonal changes and certain food intake can trigger attacks in migraine. Previous studies showed that eating attitudes and disorders are prevalant in patients with migraine. Eating disorders are psychiatric disorders related to abnormal eating habits. Both migraine and eating disorders are common in young women and personality profiles of these patient groups are also similar. A possible relationship which shows that migraine and eating habits are related can lead to a better understanding of disease pathogenesis and subsequently new therapeutic options on both entities. Association of migraine in relation to severity, depression and anxiety and eating habits and disorders were aimed to be investigated in this study. Methods The study was designed as a prospective, multi-center, case control study. Twenty-one centers from Turkey was involved in the study. The gathered data was collected and evaluated at a single designated center. From a pool of 1200 migraine patients and 958 healthy control group, two groups as patient group and study group was created with PS matching method in relation to age, body-mass index, marital status and employment status. Eating Attitudes Test-26 (EAT-26), Beck’s Depression Inventory (BDI) and Beck’s Anxiety Inventory (BAI) were applied to both study groups. The data gathered was compared between two groups. Results EAT-26 scores and the requirement for referral to a psychiatrist due to symptoms related to eating disorder were both statistically significantly higher in patient group compared to control group (p = 0.034 and p = 0.0001 respectively). Patients with migraine had higher scores in both BDI and BAI compared to control group (p = 0.0001 and p = 0.0001 respectively). Severity of pain or frequency of attacks were not found to be related to eating attitudes (r:0.09, p = 0.055). Conclusions Migraine patients were found to have higher EAT-26, BDI and BAI scores along with a higher rate of referral to a psychiatrist due to symptoms. Results of the study showed that eating habits are altered in migraine patients with higher risk of eating disorders. Depression and anxiety are also found to be common amongst migraine patients.

Sneddon syndrome may present with neurological findings such as transient ischemic stroke, strokes, seizures and/or headaches. However, a purplish, spider web-like skin finding called livedo reticularis may accompany the skin and precede neurological findings. Sneddon syndrome often affects women. Since it is vasculopathy affecting small and medium vessels, other organ findings may accompany. We present a 44-year-old Sneddon syndrome patient with monoparesis in her left lower extremity, livedo reticularis on her back and legs, and hypertension.

Multiple symmetric lipomatosis (MLS), also known as Launois-Bensaude syndrome or Madelung disease, is a rare metabolic condition characterized by generally symmetrical, non-encapsulated fat accumulations in the patient’s body. Is there a link between neurological disorders and multiple symmetric lipomatosis, as we demonstrate with our 75-year-old male patient who had an ischemic stroke and was also diagnosed with MLS? Our goal here is to provide an answer to this question.

Spinal and bulbar muscular atrophy, also known as Kennedy's disease, is a rare late-onset X linked recessive hereditary lower motor neuron disease. Kennedy's disease is caused by increased trinucleotide (CAG) repeats on the androgen receptor gene, which encodes polyglutamine on the X chromosome. The number of CAG repeats was associated with disease severity and the likelihood of early onset. Males are always affected, while female carriers may experience low-intensity symptoms. Muscle weakness and muscle atrophies, bulbar weakness, tremor, cramps, fasciculations, sensory neuropathy, gynecomastia, and sexual dysfunction are the most common clinical manifestations of Kennedy's disease. Kennedy's disease is extremely rare in most societies. We wanted to present our 66-year-old patient with progressive muscle weakness, gait disturbance, recurrent falling attacks and muscle twitches, diagnosed with Kennedy's disease as a result of genetic screening, and to draw attention to Kennedy's disease with the case we presented.

BACKGROUND:Migraine, is a common neurological disorder that may be associated with certain personality traits. This study aims to identify and compare the personality traits accompanying the clinical and sociodemographic profiles in migraine groups. METHODS:The study included a cohort of chronic, episodic migraine (CM - EM) and healthy controls (HC). Migraine was diagnosed according to the International Classification of Headache Disorders-3β criteria. Age, gender, migraine-related disease duration, number of days with a headache each month, and headache intensity of the patients were recorded. The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) was used to determine personality traits. RESULTS:The study groups were similar in terms of sociodemographic characteristics (70 CM, 70 EM, and 70 HC). The visual analog scale (VAS) score was significantly higher in CM (p < 0.05). No statistically significant difference was found between the groups concerning symptoms of migraine such as osmophobia, photophobia, phonophobia, and nausea (p > 0.05). When the personality traits were examined, the mean scores of the MMPI test results of migraine patients were found to be higher than healthy controls in line personality disorders (p < 0.05 for all personality traits). In CM patients, the 'hysteria' score was found to be higher in subgroup evaluation (p < 0.05). CONCLUSION:EM and CM patients had more evidence of personality disorders than healthy controls. CM patients had higher hysteria scores than EM patients. In addition to pain treatment, determining personality traits and providing appropriate management with a multidisciplinary approach can benefit both in terms of treatment, cost, and time.

Morgagni-Stewart-Morel (MSM) syndrome is characterized by the thickening of the frontal bone of the skull (hyperostosis frontalis interna) obesity, neurological symptoms, and hypertrichosis. We present the case of a 76-year-old patient who complained of confusion, extreme irritability, and headache and was diagnosed with MSM based on examination, imaging, and test results.

Objective Complex regional pain syndrome (CRPS) can be distinguished as type I without and type II with electrophysiological evidence of major nerve lesion. The pathophysiology of both subgroups is still under investigation. The aim of this research is to demonstrate the nerve morphology and electrophysiology in CRPS type I patients. Materials and Methods Bilateral median and ulnar nerve cross-sectional areas were evaluated with ultrasound and also median and ulnar nerve conduction studies of both hands were performed. Cross-sectional areas of median and ulnar nerves and nerve conduction studies in healthy controls were also obtained and compared with the patients. Results Twenty-five male patients and 11 healthy male controls were enrolled in the study. The mean age of the patients was 24.08 +/- 5.50 years and controls was 23.18 +/- 5.09 (p > 0.05). Compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) amplitudes of the diseased side were found significantly lower than the healthy side (p < 0.05). Both median and ulnar nerve distal motor latency values were significantly higher in the patient group (p < 0.05). There was no significant difference in the median and ulnar nerve cross-sectional area when compared with the opposite extremity and healthy volunteers. Conclusion The lower SNAP and CMAP amplitudes of the median and ulnar nerves compared to the healthy side and the prolongation of the affected side median and ulnar nerve distal motor latencies of the affected individuals may indicate axonal involvement in patients with CRPS type 1. Decreased CMAP amplitudes may also indicate muscle atrophy due to a decrease in the number of functional motor units.

Purpose: The aim of our study was to determine the effects of greater occipital nerve block (GONB) with lidocaine on sleep characteristics in patients with chronic migraine.Materials and methods: Twenty female patients who underwent GONB with lidocaine were included in the study. The Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Pre-Sleep Arousal Scale (PSAS), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Restless Legs Syn-drome Severity Scale (RLSSS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and headache diary results before and after the treatment of the patients were compared.Results: We included 20 patients (all females) in our study. The mean age was 35.80 & PLUSMN; 8.82 years (range 24-50). After GON blockade, the number of days with pain (p < 0.001), duration of pain (p < 0.001), and Visual Analog Scale (VAS) score (p < 0.001) were significantly lower than before. After GONB, BDI (p = 0.007), BAI (p = 0.022), ISI (p = 0.009), and PSQI (p = 0.026) scores were significantly lower than before. After GONB, sleep quality was better than before (p = 0.035). Conclusion: This study showed that GONB with lidocaine can improve sleep quality, insomnia, and symptoms of depression and anxiety while reducing migraine headache.

Ross syndrome is a rare disorder of unknown etiology, characterized by the triad of segmental anhidrosis, tonic pupil, and areflexia/hyporeflexia. Ross syndrome is thought to be a limited and selective ganglioneuropathy. Its etiology has not been fully elucidated. Autonomic findings may also accompany. We wanted to present our 25-year-old patient who was diagnosed with Ross syndrome and presented with complaints of inability to sweat, heat intolerance, headache, diarrhea and chronic cough. Keyword: cough, tonic pupil, anhidrosis, compensatory.