Migraine is a disabling primary headache disorder that directly affects more than one billion people worldwide. Despite its widespread prevalence, migraine remains under-diagnosed and under-treated. To support clinical decision-making, we convened a European panel of experts to develop a ten-step approach to the diagnosis and management of migraine. Each step was established by expert consensus and supported by a review of current literature, and the Consensus Statement is endorsed by the European Headache Federation and the European Academy of Neurology. In this Consensus Statement, we introduce typical clinical features, diagnostic criteria and differential diagnoses of migraine. We then emphasize the value of patient centricity and patient education to ensure treatment adherence and satisfaction with care provision. Further, we outline best practices for acute and preventive treatment of migraine in various patient populations, including adults, children and adolescents, pregnant and breastfeeding women, and older people. In addition, we provide recommendations for evaluating treatment response and managing treatment failure. Lastly, we discuss the management of complications and comorbidities as well as the importance of planning long-term follow-up.

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We report the prevalence of Siberian and Far Eastern subtypes of tick-borne encephalitis virus (TBEV) in Ixodes persulcatus and Ix. pavlovskyi ticks collected in Tomsk and its suburbs during 2006-2008. The TBEV was detected in 5.7% ticks collected in the city, where Ix. pavlovskyi ticks were dominated and 7.5% ticks from suburban foci with prevalence Ix. persulcatus ticks. Genotyping of the virus showed that Siberian subtype (89.5%) is predominant in individual ticks of Tomsk suburbs; however, the proportion of Far Eastern subtype in two urban sites reached 47%. Phylogenetic analysis demonstrated that Siberian subtype variants from individual ticks were quite divergent and original. Only one subclade was found to be similar to Zausaev strain of TBEV, which is the etiological agent of lethal chronic form of tick-borne encephalitis infection. The average level of homology of 5' noncoding region (5'-NCR) of TBEV in the individual ticks was 95% for Far Eastern subtype and 89% for Siberian subtype of TBEV. Multiple substitutions in 5'-NCR were found in viral RNA derived from individual ticks. The A2 and C1 elements of Y-shaped structure and putative site for viral RNA polymerase were most variable regions for TBEV 5'-NCR. The B1 and B2 elements and the start codon were practically conserved. The viral RNA from three TBEV-infected pig kidney embryo cells after three passages (out of 21 polymerase chain reaction-positive ticks) were found to multiple substitutions in 5'-NCR in comparison with viral RNA from individual parent tick. However, these three variants did not replicate efficiently in pig kidney embryo cells that may be connected with a considerable modification of Y-shaped structure of 5'-NCR. The efficiently replicating isolate Kolarovo had only seven substitutions in the 5'-NCR and typical Y-shaped structure for Siberian subtype of TBEV. Our data support the idea that hypervariability of the 5'-NCR reflects viral strategy to select the fittest RNA molecule for productive viral infection in mammalian and tick cells.

The tick Ixodes pavlovskyi is taxonomically, morphologically, and ecologically close to the taiga tick Ixodes persulcatus, a major host and vector of Borrelia spirochetes. The recent range of I. pavlovskyi is disjoined into the Western Siberian and Far Eastern parts, with this tick being almost always sympatric with I. persulcatus. A total of 56 unfed adult I. pavlovskyi ticks from the biotope where this species was absolutely dominant (within the city limits of Tomsk, Western Siberia) and 50 I. persulcatus ticks from the vicinity of this city, where I. pavlovskyi was almost absent, were collected by flagging in May-June 2006, at the seasonal peak of their abundance. The guts and internal organs of individual ticks were inoculated into the Barbour-Stoenner-Kelly (BSK) medium. Thus, 35 Borrelia isolates were obtained and identified by means of polymerase chain reaction-restriction fragment length polymorphism analysis and sequencing of the rrfA-rrlB spacer and, selectively, an rrs gene fragment. The Borrelia infection rate in I. pavlovskyi (35.7 +/- 12.8%) was almost the same as in I. persulcatus (30.0 +/- 13.0%). Such a high infection rate in I. pavlovskyi shows that this vector can itself maintain natural foci of borreliosis, regardless of very low abundance or even absence of I. persulcatus. In both foci compared, Borrelia garinii prevailed in ixodid ticks (31 isolates). Three B. afzelii VS461 isolates were obtained from I. pavlovskyi. Therefore, independently of whether I. pavlovskyi or I. persulcatus is the main vector, B. garinii of two genomic groups, 20047 and NT29, can circulate in a natural focus, but B. garinii NT29 is more closely associated with I. persulcatus. Moreover, two isolates (one from I. pavlovskyi and one from I. persulcatus) proved to be completely identical to B. garinii ChY13p from I. persulcatus collected in China. The hypothesis is that these and other similar isolates described previously comprise an individual genomic group of B. garinii.

Monitoring of two tick species (Ixodes persulcatus Schulze 1930 and Ixodes pavlovskyi Pomerantsev) was performed in four city parks of Tomsk, Russia (Camp Garden, University Park, Southern Cemetery, and Polytechnic Stadium) and in a control wild biotope in city environs (Kolarovo) in 2002-2013. Ticks were collected by flagging repeatedly after each 10 ± 1 days, starting from the disappearance of the snow cover till the end of tick activity (April-August). Gradual penetration of both tick species into city parks was demonstrated. In the wild biotope, I. persulcatus dominated during the whole period of monitoring, forming about 95% of tick population, whereas in urban biotopes I. pavlovskyi became the dominant species. Two peaks of population density during each season of spring-summer activity were observed in both species. Possible explanations of the phenomena are discussed.