Background: Calcitonin gene-related peptide (CGRP), vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase activating polypetide-38 (PACAP-38) have relevant roles in migraine pathophysiology. Their serum levels have been proposed as biomarkers for migraine. Our aim was to assess their diagnostic value in real clinical practice in a cohort of chronic migraine (CM), episodic migraine (EM) and healthy controls (HC). Methods: We recruited subjects with CM, EM and HC at two medical centers. Blood samples were drawn under fasting conditions in the interictal period, immediately centrifuged and stored at-80º C. Serum levels were determined by ELISA. Neuropeptide levels, the effect of preventatives, correlations with clinical and demographic variables, and their diagnostic value were studied among clinical categories. Results: 296 age-and sex-matched subjects (101 CM, 98 EM and 97 HC) were included. All three neuropeptide serum levels were higher in CM [median and IQ for CGRP= 18.023 pg/ml (14.4-24.7); VIP=
The mean age was higher in the CM group. Mean MIDAS scores were 51 ± 4.1 in CM, and 17.7 ± 15 in EM (P=.001). Adjusted means for EE were 24.6 ± 2.6 in CM patients, 16.2 ± 2.6 in EM patients, and 13.4 ± 2.3 (P=.03) in the healthy group. MIDAS scale scores were inversely correlated to PA (P<.05) DISCUSSION: Our results suggest that the level of EE at work is higher in EM than in CM patients, while PA levels decrease as impact on the MIDAS scale increases. The Maslach scale is a potentially useful tool for studying migraine impact. Surprisingly, EE is higher in patients with fewer episodes; this tendency could be related to stress adaptation mechanisms present in patients with chronic illness.
Background
Headache is a frequent symptom at the onset of Listeria meningitis, accompanied by others such as fever, altered mental status and meningeal signs, but never reported so far as an isolated symptom.
Methods and Results
Two immunocompetent males, with no history of primary headaches, went to the emergency department because of headache. The first after a sudden severe, holocranial headache without other associated symptoms, and the second after a subacute, moderate oppressive headache in temples, which 8 days later added a mild left hemiparesis. None of them had fever or meningeal signs. The initial cranial CT was unremarkable in both cases. Lumbar puncture was diagnostic for Listeria meningitis serotype IVb.
Conclusions
Listeria meningitis may present as an isolated headache, with different clinical patterns, which should be taken into account when evaluating de novo unclassified headaches according to the ICHD‐3 criteria.
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