Headache and Facial Pain Lasting Less Than Four Hours: Focus on Patients with Cranial Autonomic Features/Dört Saatten Kisa Süren Bas ve Yüz Agrilari: Kraniyal Otonomik Bulgulari Olan Hastalara Odaklanma

• Published in: Türk nöroloji dergisi Vol. 28; no. 2; p. 111
• Main Authors: Özdemir, Hüseyin Nezih, Dere, Birgül, Orujov, Asim, Baskan, Gülcan Nesem, Dorukoglu, Mehmet Mesut, Sirin, Hadiye, Çelebisoy, Nese, Gökçay, Figen
• Format: Journal Article
• Language: English
• Published: Galenos Yayinevi Tic. Ltd 01.06.2022
• Subjects: Autonomic neuropathies; Causes of; Complications and side effects; Diagnosis; Facial pain; Headache; Orofacial pain; Turkey
• ISSN: 1301-062X; 1309-2545
• DOI: 10.4274/tnd.2022.14564

Objective: The aim of our research was to evaluate the demographic and clinical features, treatment characteristics, and responses of the patients who presented to the Ege University Neurology Headache Outpatient Clinic with headaches lasting less than 4 hours. Another primary goal was to compare the characteristics mentioned above of patients with and without cranial autonomic symptoms. Materials and Methods: Our study was retrospective and cross-sectional. The findings were based on the data collected at our tertiary headache center. Headache disorder diagnoses were made in accordance with the International Classification of Headache Disorders-3 guideline. We reviewed the patients' charts and recorded the information on a standardized form. The patients' clinical features, and treatment responses were noted. The patients were divided into two groups as those with and without autonomic findings, and the above-mentioned features were compared. Treatment responses of patients with trigeminal autonomic cephalgia (TAC) and patients with trigeminal neuralgia (TN) were analyzed via logistic regression analysis. Values of p<0.05 were considered statistically significant. Results: Sixty-eight patients were included. Twenty-five patients had TAC. Twenty-three patients had TN and 13 had tension type headache. Seven had other primary headaches. The patients' clinical features and treatment responses were different in the subgroups. In patients with TAC , having a triggering factor [Odds ratio (OR): 0.059, 95% confidence interval (CI): (0.005-0.645); p=0.02] reduced the risk of need of attack treatment. In patients with TN, having a brainstem lesion on cranial magnetic resonance imaging sequences [OR: 24.776, 95% CI: (1.033-60.613); p=0.049] increased the risk of long-term treatment failure with carbamazepine, whereas having headache attacks more than once a day [OR: 0.58, 95% CI: (0.04-0.832); p=0.036] decreased the risk. Conclusion: The correct diagnosis of headache disorders is mainly based on the clinical features of the headache. For an effective treatment initiation, a correct diagnosis is mandatory, entirely dependent on adequate history taking. Keywords: Headache, face, pain, shorter Amaç: Arastirmamizin amaci Ege Üniversitesi Nöroloji Bas Agrisi Poliklinigi'ne 4 saatten kisa süren bas agrisi ile basvuran hastalarin demografik ve klinik özelliklerini, tedavi özelliklerini ve tedavi yanitlarini degerlendirmektir. Bir diger ana amaç ise kraniyal otonomik bulgulara sahip olan ve sahip olamayan hastalarin yukarida belirtilen özelliklerini karsilastirmaktir. Gereç ve Yöntem: Çalismamiz retrospektif ve kesitseldir. Bulgular, üçüncül bas agrisi merkezimizde toplanan verilere dayanmaktadir. Bas agrisi bozukluklarinin tanilari International Classification of Headache Disorders-3 kilavuzuna göre konmustur. Hastalarin dosyalari incelenmistir ve bilgileri standart bir olgu rapor formuna kaydedilmistir. Hastalarin demografik özellikleri, klinik özellikleri ve tedavi yanitlari not edilmistir. Hastalar otonomik bulgulara sahip olan ve sahip olamayan hastalar olarak iki gruba ayrilmistir ve yukarida belirtilen özellikleri karsilastirilmistir. Trigeminal otonomik sefalji ve trigeminal nevralji (TN) hastalarinin tedavi yanitlari lojistik regresyon analizi ile degerlendirilmistir. p<0,05 degerleri istatistiksel olarak anlamli kabul edilmistir. Bulgular: Altmis sekiz hasta dahil edildi. Yirmi bes hastada trigeminal otonomik sefalji vardi. Yirmi üç hastada TN, 13 hastada gerilim tipi bas agrisi vardi. Yedi hastada baska birincil bas agrisi vardi. Hastalarin klinik özellikleri ve tedavi yanitlari alt gruplarda farkliydi. Trigeminal otonomik sefalji hastalarinda tetikleyici faktör tarif etmenin atak tedavisi alma riskini düsürdügü saptandi [Odds orani (OR): 0,059, %95 güven araligi (GA): (0,005-0,645); p=0,02]. TN hastalarinda beyin sapi lezyonuna sahip olmak [OR: 24,776, %95 GA: (1,033-60,613); p=0,049] uzun dönemde karbamazepin tedavisinde basarisizlik riskini artirirken günde birden fazla nevralji atagi yasamak [OR: 0,58, %95 GA: (0,04-0,832); p=0,036] azaltmaktaydi. Sonuç: Bas agrisi bozukluklarinin dogru teshisi, temel olarak bas agrisinin klinik özelliklerine dayanir. Etkili bir tedavi için dogru bir teshis zorunludur, dogru teshis tümüyle uygun öykü alinmasina dayanmaktadir. Anahtar Kelimeler: Bas agrisi, yüz, agri, kisa