The relationships between migraine and A-V Malformations is a subject of controversy and the arguments are mainly based on case reports and retrospective data. To clarify this subject a structured inquiry and classification of headaches in large samples of patients with intracranial vascular malformations (IVM) is essential. The authors studied the prevalence of headaches in 51 patients with IVM admitted to our Department, between 1984 and 1992. The methods used were a review of medical records followed by a self-administered headache questionnaire and clinical interview using the IHS criteria for the diagnostic classification of headaches. The relative frequency of the different types of headaches was calculated and compared with the general population data. A correlative study of the headache characteristics with the type and location of the IVM was made. A high prevalence (47%) of migraine type headaches and a strong positive correlation (88.8%) between the site of AVM and side of the pain was found. This is highly suggestive but not conclusive of a pathophysiologic relationship between these entities. The conclusion drawn is that a prospective study of headaches by questionnaire or semi-structured clinical interview in patients with IVM is essential to discover the effective prevalence and characteristics of headaches associated with IVM and their relationships.

Approximately 60 cases of spinal angiolipomas have been described in the medical literature. Extradural tumours predominate. Lesions with a bony component, the infiltrating subgroup, were reported in 10 patients. Intradural angiolipomas were found three times. Several excellent review articles are available, but a systematic comparison of the characteristics of the two major varieties, infiltrating and non-infiltrating spinal extradural angiolipomas, has not so far been made. The authors operated on two patients with spinal angiolipomas and found one of them the infiltrating and the other the non-infiltrating type. Then, they proceeded to a review of all publish cases of infiltrating angiolipomas. With a knowledge of recently reported data on the subject the authors compared essential clinical features of both varieties of tumours. They share identical clinical characteristics. Differences found in age, sex or location were not statistically significant. Mode of onset and signs and symptoms present on admission were essentially similar. As could be anticipated, removal was more often complete in non-infiltrating tumours, but outcome was good or fair in more than 85% of cases in both groups. Involvement of bone by spinal angiolipomas does not imply a worsening in the prognosis.

No abstract

In a cohort of hypertensive patients, high salt intake independently predicts the occurrence of CV events, particularly of stroke.

The objective of this study was to evaluate the long-term predictive value of the haemostatic, inflammatory and haemorheologic disturbances in transmural myocardial infarction (MI). Sixty-four (59 male) consecutive survivors of a MI, with a mean age of 58.3 +/- 12.0 years, were followed over a period of 36 months. Eighteen patients had a cardiovascular event defined as the composite of death, non-fatal MI, unstable angina and stroke. The haemostatic (protein C activity-PtC, antithrombin III, plasminogen activator inhibitor-1), haemorheologic (blood fluidity and components, erythrocyte membrane fluidity) and inflammatory (polymorphonuclear elastase, leukocyte count) profiles were determined at hospital discharge, using standard methodology. Our results can be summarized as follow: (i) at hospital discharge, the subgroup of patients with events had higher leukoactivity, leukocyte count, membrane fluidity, prognosis cyte count (7833.0 +/- 1696.0 vs. 10294.0 +/- 3129.0; p = 0.011), lower PtC (100.65 +/- 19.08 vs.81.25 +/- 19.95; p = 0.002), and lower erythrocyte aggregation (14.26 +/- 5.94 vs. 11.47 +/- 3.45; p = 0.031) in relation to the ones without events; (ii) By Cox regression the protein C activity lower tertile (OR 0.169; 0.045-0.628; p = 0.008); erythrocyte membrane outer layer fluidity upper tertile (OR 0.067; 95% CI 0.011 - 0.393; p = 0.003); and erythrocyte aggregation lower tertile (OR 0.182; 0.038 - 0.876; p = 0.034) were independent predictors of the composite endpoint. We can conclude that some haemostatic, haemorheologic and inflammatory disturbances, at hospital discharge, are long-term independent predictors of recurrent cardiovascular events in transmural myocardial infarction survivors.

Migraine is highly prevalent and carries a significant personal, social and economic burden. It is the second cause of disability (years living with disability) worldwide and the first cause under 50 years of age. Chronic migraine (occurring for more than 15 days a month) and refractory migraine (treatment resistant), especially when there is also analgesic overuse, are the most disabling forms of migraine. These three disorders (chronic migraine, refractory migraine and medication overuse headache) are particularly difficult to treat. This article reviews their epidemiology, clinical presentation, diagnostic criteria, risk factors, comorbidities and social and personal impact. The therapeutic options available are discussed and focused on a multidisciplinary approach, non-pharmacological interventions treatment of comorbidities and avoiding analgesic overuse. Prophylactic treatments are mandatory and include the oral prophylactic treatments (topiramate), botulinum toxin type A and the novel monoclonal antibodies against calcitonin gene related peptide or its receptor, which are the first migraine preventive medicines developed specifically to target migraine pathogenesis. In refractory cases, multiple therapies are required including neurostimulation.

Several studies suggest a strong familial aggregation for cluster headache (CH), but so far none of them have included subjects with probable cluster headache (PCH) in accordance with the International Classification of Headache Disorders. Objective: To identify cases of probable cluster headache and to assess the familial aggregation of cluster headache by including these subjects. Method: Thirty-six patients attending a headache consultation and diagnosed with trigeminal autonomic headaches were subjected to a questionnaire-based interview. A telephone interview was also applied to all the relatives who were pointed out as possibly affected as well as to some of the remaining relatives. Results: Twenty-four probands fulfilled the criteria for CH or PCH; they had 142 first-degree relatives, of whom five were found to have CH or PCH, including one case of CH sine headache. The risk for first-degree relatives was observed to be increased by 35-to 46-fold. Conclusion: Our results suggest a familial aggregation of cluster headache in the Portuguese population.Keywords: cluster headache, probable cluster headache, familial aggregation, cluster headache sine headache, first-degree relatives. REsumoDiversos artigos sugerem uma significativa agregação familiar da cefaleia em salvas (CH) embora nenhum tenha incluído indivíduos com provável cefaleia em salvas (PCH), segundo critérios da Classificação Internacional de Cefaleias (ICHD-II). Objetivo: Encontrar casos de provável cefaleia em salvas e avaliar a agregação familiar da cefaleia em salvas incluindo também esses indivíduos. Método: Foi aplicado um questionário por telefone a 36 doentes que frequentaram uma Consulta de Cefaleias com diagnóstico de cefaleia trigémino-autonómica. Todos os familiares de primeiro grau referidos como possivelmente afetados e alguns dos restantes foram entrevistados por telefone. Resultados: Em 24 doentes foi diagnosticada CH ou PCH e estes tinham 142 familiares de primeiro grau, cinco dos quais foram diagnosticados como CH ou PCH, incluindo um caso de CH sem cefaleias. O risco para familiares de primeiro grau foi 35-46 vezes superior ao da população geral. Conclusão: Nossos resultados sugerem a existência de uma agregação familiar da cefaleia em salvas na população portuguesa.Palavras-chave: cefaleia em salvas, provável cefaleia em salvas, agregação familiar, cefaleia em salvas sem cefaleia, familiares de primeiro grau.

Medica students of the Instituto de Ciências Biomédicas ''Abel Salazar'' at the University of Oporto were interviewed using a structured headache questionnaire in order to assess the prevalence and characteristics of headaches in a young adult university population. This was the first population-based study of headaches in Portugal. 491 students were questioned. The parameters evaluated included age, sex, headache characteristics (frequency, localization, severity, duration), premonitory and associated symptoms and family history. Headaches were classified using the Ad Hoc Committee (1962) and the International Headache Society (1988) criteria. There was a high prevalence of overall headaches in this young population. The results of the application of these two types of criteria to the same population showed for the most prevalent forms, migraine and tension-type headaches, a prevalence that depends on the classification adopted and the number of criteria items considered. If all (9 items) were used, the statistics obtained for migraine were 6.9% (Ad Hoc) and 6.1% (IHS), an insignificant difference, and for tension-type headache 14.3% (Ad Hoc) and 16.0% (IHS), which corresponds to a significant difference (p = 0.0129, McNemar test). It is concluded that IHS classification criteria identify less cases of migraine and more cases of tension-type headaches, which means a higher specificity for migraine and a higher sensitivity for tension-type headache.