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Background and Objectives: Blood-brain barrier (BBB) disruption has been proposed to be important in the pathogenesis of reversible cerebral vasoconstriction syndrome (RCVS), but not all patients present an identifiable macroscopic BBB disruption; that is, visible contrast leakage on contrast-enhanced T2 fluid-attenuated inversion recovery imaging. This study aimed to evaluate microscopic BBB permeability and its dynamic change in patients with RCVS., Methods: This prospective cohort implemented 3T dynamic contrast-enhanced MRI. We measured microscopic BBB permeability by determining the whole-brain and white matter hyperintensity (WMH) K trans values and evaluated the correlation of whole-brain K trans permeability with clinical and vascular measures in transcranial color-coded sonography., Results: In total, 176 patients (363 scans) were analyzed and separated into acute (≦30 days) and remission (≧90 days) groups based on the onset-to-examination time. Whole-brain K trans values were similar between patients with and without macroscopic BBB disruption in either acute or remission stage. The whole-brain K trans was significantly decreased ( p < 0.001) from acute to remission stages. The WMH K trans was significantly higher than mirror references and decreased from acute to remission stages ( p < 0.001). Whole-brain K trans correlated with mean pulsatility index ( r s = 0.5, p = 0.029), mean resistance index ( r s = 0.662, p = 0.002), and distal-to-proximal ratio of resistance index ( r s = 0.801, p < 0.001) of M1 segment of middle cerebral arteries at around 10-15 days after onset. The time-trend curve of whole-brain K trans depicted dynamic changes during disease course, similar to temporal trends of vasoconstrictions and WMH., Discussion: Patients with RCVS presented increased microscopic brain permeability during acute stage, even without discernible macroscopic BBB disruption. The dynamic changes in BBB permeability may be related to impaired cerebral microvascular compliance and WMH formation., (© 2021 American Academy of Neurology.)

Objectives: To identify the frequency, clinical effects, and suicide risk in comorbid fibromyalgia(FM) among patients with migraine., Methods: We surveyed patients with migraine who attended a headache clinic. All patients completed questionnaires containing demographics, headache profiles based on the International Classification of Headache Disorders, 2nd edition, FM questionnaires based on the modified 2010 American College of Rheumatology preliminary diagnostic criteria, Migraine Disability Assessment, Hospital Anxiety and Depression Scale, and Pittsburgh Sleep Quality Index. Suicide risk was evaluated by self-report of lifetime suicidal ideation and attempts., Results: Of the 1,318 recruited patients with migraine (aged 42.6 ± 12.7 years; female/male = 4.5), 10.1% (aged 44.3 ± 12.6 years; female/male = 7.9) had comorbidity of FM. Patients with migraine and comorbid FM had higher headache frequency and headache-related disability, poor sleep quality, and were more depressed/anxious than those with migraine only (p < 0.001). Suicidal ideation and attempts were reported in 27.3% and 6.9% of patients with migraine, respectively, and were higher in patients with comorbid FM than in those without (ideation: 58.3% vs 24%; attempt: 17.6% vs 5.7%; p < 0.001). In addition, comorbidity of FM was associated with a higher suicide risk in 3 different migraine subgroups, i.e., migraine without aura, migraine with aura, and chronic migraine. After controlling for covariates, comorbidity of FM remained as a predictor of suicidal ideation and attempts (odds ratio 2.61 and 1.99, respectively, p < 0.05)in patients with migraine., Conclusions: Comorbidity with FM is associated with a high suicide risk in patients with migraine.

Objective: We aimed to investigate whether reversible cerebral vasoconstriction syndrome (RCVS) could recur and to identify the potential predictors of recurrence in a large cohort of patients., Methods: This study followed a cohort of 210 patients with RCVS in a hospital-based headache center from 2000 to 2012. All patients were regularly followed up by telephone after remission for RCVS and were particularly asked to return to our hospital immediately if they developed new acute, severe (i.e., thunderclap-like) headaches. Sequential neuroimaging studies were used to determine whether the patients had recurrent RCVS., Results: One hundred sixty-eight patients were successfully followed. The response rate was 80.8%, and the mean follow-up period was 37.5 ± 24.4 (range 6-131) months. Eighteen patients (10.7%) returned to our hospital because of new thunderclap-like headaches, and 9 (5.4% of the total 168, and 50% of 18) were confirmed to have recurrent RCVS that occurred a mean 40.9 ± 27.2 (median 35, range 6-87) months after the initial bout. The incidence rate was 1.71 per 100 person-years (95% confidence interval 1.68-1.75). Having sexual activities as a trigger for thunderclap headaches (hazard ratio = 5.68, 95% confidence interval 1.11-29.15, p = 0.038) was an independent predictor of recurrent RCVS. None of the patients with recurrent RCVS developed cerebrovascular complications., Conclusions: Recurrent RCVS should be considered when patients with RCVS develop new thunderclap-like headaches. Having sexual activities as a trigger for RCVS is a potential predictor of recurrent RCVS., (© 2015 American Academy of Neurology.)

Objective: To evaluate the association between migraine and Bell palsy and to examine the effects of age, sex, migraine subtype, and comorbid risk factors for Bell palsy., Methods: This nationwide cohort study was conducted using data from the Taiwan National Health Insurance Research Database. Subjects aged 18 years or older with neurologist-diagnosed migraine from 2005 to 2009 were included. A nonheadache age- and propensity score-matched control cohort was selected for comparison. All subjects were followed until the end of 2010, death, or the occurrence of a Bell palsy event. Cox proportional hazards regression was used to calculate the adjusted hazard ratios and 95% confidence intervals to compare the risk of Bell palsy between groups., Results: Both cohorts (n = 136,704 each) were followed for a mean of 3.2 years. During the follow-up period, 671 patients (424,372 person-years) in the migraine cohort and 365 matched control subjects (438,677 person-years) were newly diagnosed with Bell palsy (incidence rates, 158.1 and 83.2/100,000 person-years, respectively). The adjusted hazard ratio for Bell palsy was 1.91 (95% confidence interval, 1.68-2.17; p < 0.001). The association between migraine and Bell palsy remained significant in sensitivity analyses, and tests of interaction failed to reach significance in all subgroup analyses., Conclusion: Migraine is a previously unidentified risk factor for Bell palsy. The association between these 2 conditions suggests a linked disease mechanism, which is worthy of further exploration., (© 2014 American Academy of Neurology.)

Background: Awareness is growing among clinicians of the importance of suicidal ideation in adolescents., Objectives: To investigate the relationship between migraine and suicidal ideation in a nonreferred sample of adolescents., Methods: This study surveyed migraine and depression in three middle schools in Taitung County, Taiwan. All students completed the questionnaires, including demographics, a validated headache questionnaire, the Adolescent Depression Inventory (ADI), and the Pediatric Migraine Disability Assessment (PedMIDAS) questionnaire. This study used the presence or absence of suicidal ideation as indicated by the ADI for the analysis., Results: A total of 3,963 (2,040 male and 1,923 female; mean age 14.0 +/- 0.9 years) adolescents (93% of the target cohort) completed this study. Suicidal ideation was reported in 8.5% of the study group. Compared with nonmigraine subjects (6.2%), subjects with migraine displayed a higher frequency of suicidal ideation (16.1%; odds ratio [OR] = 2.9, 95% confidence interval [CI] 2.3-3.6; p < 0.001), especially those with migraine with aura (23.9%; OR = 4.6 [95% CI 3.0-7.0]; p < 0.001). Suicidal ideation was associated with higher headache frequency and headache-related disability as measured by the PedMIDAS. After controlling for depression score and sociodemographic characteristics, the association remained only for migraine with aura (adjusted OR = 1.79 [95% CI 1.07-2.99]; p = 0.025) and high headache frequency (>7 days/month; adjusted OR = 1.69 [95% CI 1.12-2.56]; p = 0.013) but not for migraine without aura or probable migraine or PedMIDAS score., Conclusions: This study identified a higher frequency of suicidal ideation in younger adolescents with migraine with aura or high headache frequency. These associations were independent of depressive symptoms. ADI = Adolescent Depression Inventory; AOR = adjusted odds ratio; CI = confidence interval; 5-HT = serotonin; ICHD-2 = International Classification of Headache Disorders, Second Edition; MINI-Kid = Mini-International Neuropsychiatric Interview-Kid; OR = odds ratio; PedMIDAS = Pediatric Migraine Disability Assessment.

Objectives: To investigate the prevalence and correlates of comorbid psychiatric disorders and suicidal risk in community-based adolescents with chronic daily headache (CDH)., Methods: We identified and recruited 122 adolescents with CDH from a non-referral student sample (n = 7,900). CDH subtypes were classified according to the most updated criteria of the International Classification of Headache Disorders, 2nd edition (ICHD-2). An in-person psychiatric interview was performed with each subject with CDH to assess depressive and anxiety disorders and suicidal risk based on the Mini-International Neuropsychiatric Interview-Kid (MINI-Kid). Clinical correlates and impacts were investigated., Results: A total of 121 subjects (31 male/90 female, mean age 13.8 years) finished the psychiatric interview. Fifty-seven subjects (47%) had > or =1 assessed psychiatric comorbidity with major depression (21%) and panic disorder (19%) as the two most common diagnoses. Current suicidal risk was assessed as high (score > or = 10) in 20% of subjects. Female gender and older age were associated with depressive disorders. Presence of migraine was associated with psychiatric comorbidities (OR = 3.5, p = 0.002). The associations with psychiatric disorders were stronger for migraine with aura than for migraine without aura. Migraine with aura also independently predicted a high suicidal risk (score > or = 10) (adjusted OR = 6.0, p = 0.028). In contrast, CDH subtypes, headache frequencies, or medication overuse were not correlated. Comorbid psychiatric disorders were not related to physician consultations or more days of sick leave., Conclusions: This community-based study showed high comorbidity of psychiatric disorders and suicidal risk in adolescents with chronic daily headache. The presence of migraine attacks, especially migraine with aura, was the major predictor for these associations.

Eleven patients with primary thunderclap headache (TCH) were treated with oral nimodipine 30 to 60 mg every 4 hours or IV nimodipine 0.5 to 2 mg/h if the oral regimen failed or images showed cerebral vasospasm. With oral nimodipine, headache did not recur in the nine patients without vasospasm. IV nimodipine was given in two patients with vasospasm, including one who developed ischemic stroke. Nimodipine may be effective for TCH. Vasospasm may warrant IV nimodipine.

The authors measured the average diameter of bilateral superior ophthalmic veins (SOV) in 13 patients with spontaneous intracranial hypotension (SIH) on contrast-enhanced, coronal, T1-weighted MRI. Compared with sex- and age-matched neurology inpatients with normal CSF pressure, the SIH group had a smaller SOV diameter (0.90 vs 1.85 mm, p < 0.001), which partly reversed after treatment (1.09 vs 0.90 mm, p = 0.045, n = 7). Collapsed SOV might provide an additional MRI finding for SIH.

Objective: To investigate the prevalence, risk factors, and prognosis of chronic daily headache (CDH) in a population of elderly Chinese subjects., Methods: A community-based survey of registered residents > or =65 years old (n = 2,003) in two townships of Kinmen Island in 1993. A neurologist used a structured questionnaire and clinical interview to make the diagnosis of headache. Subjects who had headaches > or =15 days/month for > or =6 months in the previous year were considered to have CDH. CDH was further classified into chronic tension-type headache (CTTH), CDH with migrainous features (CDH/MF), and other CDH. Person-to-person biannual follow-up of the subjects with CDH was done in June 1995 and August 1997., Results: A total of 1,533 people (77%) participated in our prevalence study. Sixty subjects (3.9%) fulfilled the criteria for CDH, with a higher prevalence in women (F/M: 5.6%/1.8%, p < 0.001). Of these subjects, 42 (70%) had CTTH, 15 (25%) had CDH/MF, and 3 (5%) had other CDH. Only 23% of those with CDH had consulted physicians for their headaches in the previous year. Multivariate logistic regression revealed the significant risk factors for CDH to be analgesic overuse (OR = 79), a history of migraine (OR = 6.6), and a Geriatric Depression Scale-Short Form score of > or =8 (OR = 2.6). The follow-up results in 1995 and 1997 showed that about two-thirds of the subjects still had CDH. Analgesic overuse (relative risk = 1.6) in 1993 was a significant predictor of persistent CDH at follow-up., Conclusions: A total of 3.9% of this elderly population had CDH, with CTTH being the most common subtype. Almost two-thirds of those with CDH had persistent frequent headaches at follow-up. Analgesic overuse was a significant predictor of a poor outcome.

Objective: To calculate the frequencies of apolipoprotein E (apoE) alleles in a large Chinese community sample and to compare the serum cholesterol levels of epsilon2, epsilon3, and epsilon4 carriers., Background: In comparison with Western populations, a lower frequency of the apoE epsilon4 allele among the Chinese has been proposed as one factor for the lower prevalence of AD found in Chinese populations, but there are insufficient Chinese data on epsilon4 frequency that are based on large community samples. In addition, although Western studies have repeatedly found a lower cholesterol level in epsilon2 carriers and a higher cholesterol level in epsilon4 carriers in comparison with epsilon3 homozygotes, two Chinese studies have yielded inconsistent findings between them., Methods: During the incidence phase of an epidemiologic survey of several neurologic disorders in a Chinese community, the authors took blood samples from 2,326 participants to determine the apoE genotypes and to measure cholesterol levels., Results: The allelic frequencies of epsilon2, epsilon3, and epsilon4 were 11.8%, 76.4%, and 11.8% among 17 AD patients, and 7.8%, 84.1%, and 8.1% for the entire sample. The mean cholesterol level of the epsilon2 carriers was significantly lower, and that of the epsilon4 carriers significantly higher, than that of the epsilon3 homozygotes., Conclusions: The obtained epsilon4 rate of 8.1% is lower than most of the Western findings, and this may account in part for the lower prevalence of AD found among the Chinese. The associations between the apoE genotype and serum cholesterol level are similar between Chinese and white populations.

Objective: To investigate the prevalence of headaches in a Chinese elderly population., Background: There are few headache surveys in the elderly. Previous studies have shown a low headache prevalence in Chinese., Target Population: eligible registered residents > or = 65 years old (N = 2,003) in two townships of Kinmen Island on August 1, 1993. All participants completed a headache questionnaire and underwent clinical evaluation and examination by a neurologist. Headache diagnoses were made according to the International Headache Society, 1988., Results: 1,533 persons (77%) participated in the study, of whom 584 (38%) had at least one episode of headache in the previous year. One-year prevalence of migraine was 3.0%, and tension-type headache, 35%. The prevalence of migraine, but not tension-type headaches, continued to decline with age in the elderly. Life-time prevalence of "incapacitating headache" was 10%, and that of migraine, 5.2%. Forty-two percent of migraineurs stopped having migraine before this survey. In comparison with "10 years ago" 8% participants felt their current headaches were worse, 25% better, and 67%, no change, with a net improvement of 17%., Conclusions: We have reported the highest headache prevalence among different Chinese elderly populations, but these were still lower than those reported from Western series. More than half of the elderly life-time migraineurs still had attacks of migraine. Severe headaches, including migraine but not tension-type headaches, declined with age.

We examined the apolipoprotein E genotype in 56 Chinese patients with late-onset sporadic Alzheimer's disease (AD) and 57 Chinese control subjects of similar age. The frequency of epsilon 4 in the AD group was significantly higher than that in the control group (23.2% versus 7.9%, p = 0.003). The odds ratio for AD in individuals with either one or two epsilon 4 was 2.96 (95% CI 1.11 to 8.03). The linear trend for AD in proportion to alleles of epsilon 4 was also significant (chi 2 = 8.2, p = 0.004). Our results support the association between epsilon 4 and AD in the Chinese.

The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) provides ratings of an individual's changes in everyday cognitive functions during the previous 10 years. Original studies conducted in Australia showed that its score was not influenced by the subjects' educational backgrounds and that it performed at least as well as the Mini-Mental State Examination (MMSE) as a screening instrument for dementia. The subjects of the present study were Chinese and included 399 community residents and 61 dementia patients. Their ages ranged from 50 to 92 years; their education levels ranged from 0 to 19 years, and 63% of them had never attended school. We administered the IQCODE to informants and the Cognitive Abilities Screening Instrument (CASI), from which a CASI-estimated score of the MMSE (MMSE-CE) can be obtained, to the subjects. The diagnosis of dementia was made independently by physicians according to the DSM-III-R criteria based on semistructured interview and testing, neurologic examination, and standardized assessments of cerebral vascular disease, Parkinson's disease, and depression. The Chinese IQCODE showed no association with the subjects' education level or gender, low association with their age, and moderately high association with their MMSE-CE score. The area under the receiver operating characteristic curve of the IQCODE was significantly larger than that of the MMSE-CE for the whole group and for the subgroup with 1 to 19 years of education but not for the subgroup with 0 years of education. Nine of the 26 items of the IQCODE could be deleted without appreciable reduction in sensitivity and specificity. The IQCODE (1) can be shortened to 17 items, (2) had good cross-cultural applicability, and (3) was better than the MMSE-CE as a screening tool for dementia in a population with large variation in educational backgrounds.