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Introduction
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Publications
Publications (165)
Background and purpose:
In patients diagnosed with spontaneous intracranial hypotension (SIH), microspurs are considered the culprit lesion in most ventral dural leaks (type I). The imaging characteristics of discogenic spurs, and their prevalence in the general population has not been reported in the literature.
Materials and methods:
This obse...
ZUSAMMENFASSUNG
Die Kopfschmerzklassifikation der International Headache Society unterscheidet in ihrem Kapitel 4 verschiedene primäre Kopfschmerzerkrankungen, die als selten gelten und als eigenständige Entitäten aufgefasst werden. Zu diesen gehören der primäre Hustenkopfschmerz, der primäre Anstrengungskopfschmerz, der primäre Sexualkopfschmerz,...
Gemeinsam organisiert von der Schweizerischen Kopfwehgesellschaft SKG mit der Deutschen Migräne- und Kopfschmerzgesellschaft e.V. DMKG und der Österreichischen Kopfschmerzgesellschaft ÖKSG
Visual snow is the main symptom of visual snow syndrome, a disorder of predominantly visual disturbances initially described in patients without abnormalities on ancillary investigations. We present a case series of patients with visual snow in the setting of acute ischemic stroke. The first and second patient reported previous episodic visual snow...
Background and objectives
Taking a detailed history of symptoms is important for differentiating incipient ischemic stroke and migraine aura. The aim of our study is to describe in detail symptom type and temporal pattern of symptom evolution (i.e., symptom succession and the time lapse between symptoms) and to identify differentiating clinical fea...
Background:
Response predictors to erenumab (ERE) in migraine patients would benefit their clinical management. We investigate associations between patients' clinic characteristics and polymorphisms at CALCRL and RAMP1 genes and response to ERE treatment measured as clinically meaningful improvement of the headache impact test 6 (HIT-6) score.
Me...
Background and objectives To assess the usefulness of the “index vein” for making the diagnosis of migraine aura.
Methods 400 patients were included when they: i) presented with an acute neurological deficit, ii) had a brain MRI, and iii) had a discharge diagnosis of migraine aura, ischemic stroke, epileptic seizure or controls (n = 100 per group)....
Background
The fully human monoclonal antibody erenumab, which targets the calcitonin gene-related peptide (CGRP) receptor, was licensed in Switzerland in July 2018 for the prophylactic treatment of migraine.
To complement findings from the pivotal program, this observational study was designed to collect and evaluate clinical data on the impact of...
Migraine is the most common neurological disorder and can be associated with a high degree of disability. In addition to non-pharmacological approaches to reduce migraine frequency, pharmacological migraine preventatives are available. Evidence-based guidelines from the German Migraine and Headache Society (DMKG), and German Society for Neurology (...
Zusammenfassung
Migräne ist die häufigste neurologische Erkrankung und kann mit einem hohen Grad der Beeinträchtigung einhergehen. Neben nichtmedikamentösen Ansätzen zur Reduktion der Migränefrequenz stehen medikamentöse Migräneprophylaxen zur Verfügung. Zur Indikation und Anwendung liegen evidenzbasierte Leitlinien der Deutschen Migräne- und Kopfs...
Background and objectives
In general, suddenly occurring neurological deficits, i.e., negative neurological symptoms, are considered symptoms of focal cerebral ischemia, while positive irritative symptoms with gradual onset are viewed as the characteristics of migraine aura. Nevertheless, cortical spreading depolarization, the pathophysiological ba...
Visual snow syndrome is characterized by a continuous visual disturbance resembling a badly-tuned analogue television and additional visual and non-visual symptoms causing significant disability. The natural course of visual snow syndrome has not hitherto been studied. In this prospective longitudinal study, 78 patients with the diagnosis of visual...
Purpose
Epidural blood patch (EBP) is a minimally invasive treatment for spontaneous intracranial hypotension (SIH). Follow-up after EBP primarily relies on clinical presentation and data demonstrating successful sealing of the underlying spinal cerebrospinal fluid (CSF) leak are lacking. Our aim was to evaluate the rate of successfully sealed spin...
Introduction
Chronic headache due to the overuse of medication for the treatment of migraine attacks has a prevalence of 0.5–2.0%. This guideline provides guidance for the management of medication overuse (MO) and medication overuse headache (MOH).
Recommendations
Treatment of headache due to overuse of analgesics or specific migraine medications...
[This corrects the article DOI: 10.3389/fneur.2022.884752.].
Objective
Spontaneous intracranial hypotension (SIH), which is often caused by a spinal cerebrospinal fluid leak, is an important cause of disabling headaches. Many patients report devastating changes in their quality of life because of their symptoms. This study aimed to evaluate the impact of SIH on patients’ social/ working life and health-relat...
Background
Visual snow syndrome is a phenomenon for which no effective treatment is known. It is highly comorbid with migraine, therefore we performed a retrospective chart review of patients with visual snow syndrome treated with a monoclonal antibody against calcitonin gene related peptide or its receptor.
Findings
We enrolled 15 patients with v...
Spontaneous intracranial hypotension is caused by loss of CSF at the level of the spine. The most frequent symptom of this disorder is orthostatic headache, with the headache worsening in the upright position and subsiding after lying down. Neuroimaging has a crucial role in diagnosing and monitoring spontaneous intracranial hypotension, because it...
Background
Erenumab (ERE) is the first anti-calcitonin gene related peptide (CGRP) receptor monoclonal antibody approved for migraine prevention. A proportion of patients does not adequately respond to ERE.
Methods
Prospective, multicenter study involving 110 migraine patients starting ERE 70 mg monthly. Baseline socio-demographics and migraine ch...
Better drugs are needed for common epilepsies. Drug repurposing offers the potential of significant savings in the time and cost of developing new treatments. In order to select the best candidate drug(s) to repurpose for a disease, it is desirable to predict the relative clinical efficacy that drugs will have against the disease. Common epilepsy c...
Background
Headache is a frequent symptom following COVID-19 immunization with a typical onset within days post-vaccination. Cases of cerebral venous thrombosis (CVT) have been reported in adenovirus vector-based COVID-19 vaccine recipients.
Findings
We reviewed all vaccine related CVT published cases by April 30, 2021. We assessed demographic, cl...
Abstract Objective Patients with visual snow syndrome (VSS) suffer from a debilitating continuous (“TV noise-like”) visual disturbance. They report problems with vision at night and palinopsia despite normal visual acuity. The underlying pathophysiology of VSS is largely unknown. Currently, it is a clinical diagnosis based on the patient’s history,...
Background
Patients with migraine are at increased risk of stroke. We aim to systematically review the current literature on the association between migraine and atrial fibrillation, which is a relevant risk factor for stroke.
Methods
We searched Pubmed for ‘migraine’ AND ’atrial fibrillation’ and selected original investigations on the associatio...
Aims
To gather information on useful medications to treat visual snow syndrome (VSS) as well as to validate an instrument to assess its clinical severity and the course of the disorder over time.
Methods
Four hundred patients with VSS were included in this web-based prospective questionnaire study. All subjects completed a treatment questionnaire...
Chimeric antigen receptor (CAR) T‑cells are genetically engineered to give T‑cells the ability to attack specific cancer cells, and to improve outcome of patients with refractory/relapsed aggressive B‑cell malignancies. To date, several CAR T‑cell products are approved and additional products with similar indication or extended to other malignancie...
Aim: By reviewing the existing clinical studies about visual snow (VS) as a symptom or as part of visual snow syndrome (VSS), we aim at improving our understanding of VSS being a network disorder.
Background: Patients with VSS suffer from a continuous visual disturbance resembling the view of a badly tuned analog television (i.e., VS) and other vis...
Background:
Visual phenomena are of many different kinds; their differential diagnosis is usually possible with directed history-taking. In this review, we describe common visual phenomena that must be distinguished from a migraine aura.
Methods:
This review is based on publications retrieved by a selective search in PubMed and the Web of Knowle...
BACKGROUND AND PURPOSE: The correlation between imaging findings and clinical status in patients with idiopathic intracranial hypertension is unclear. We aimed to examine the evolution of idiopathic intracranial hypertension–related MR imaging findings in patients treated with venous sinus stent placement.
MATERIALS AND METHODS: Thirteen patients...
Purpose: We hypothesized that due to its specific characteristics, the CasperTM RX carotid stent (CP) might be particularly suitable for venous sinus stenting (VSS) in patients with idiopathic intracranial hypertension (IIH). To test this theory, we compared it to the commonly used Precise Pro RXTM stent (PP).
Methods: A total of 15 patients with...
Purpose: We hypothesized that due to its specific characteristics, the CasperTM RX carotid stent (CP) might be particularly suitable for venous sinus stenting (VSS) in patients with idiopathic intracranial hypertension (IIH). To test this theory, we compared it to the commonly used Precise Pro RXTM stent (PP).
Methods: A total of 15 patients with I...
Smarter Medicine in Headache Care - presentation and discussion of 5 recommendations Abstract. An unequivocal headache diagnosis cannot always be made. The lack of diagnostic tests able to prove primary headaches often prompts physicians to perform unnecessary examinations to reduce their uncertainty. When setting out the therapeutic strategy, agai...
Objective:
The aim of this narrative review is to explore the relationship between visual snow syndrome (VSS), migraine, and a group of other perceptual disorders.
Background:
VSS is characterized by visual snow and additional visual and nonvisual disturbances. The clinical picture suggests a hypersensitivity to internal and external stimuli. Im...
Smarter Medicine in Headache Care - presentation and discussion of 5 recommendations Abstract. An unequivocal headache diagnosis cannot always be made. The lack of diagnostic tests able to prove primary headaches often prompts physicians to perform unnecessary examinations to reduce their uncertainty. When setting out the therapeutic strategy, agai...
Objectives:
We aimed to investigate changes in regional cerebral blood flow (rCBF) using arterial spin labelling (ASL) in patients with visual snow syndrome (VSS), in order to understand more about the underlying neurobiology of the condition, which remains mostly unknown.
Methods:
We performed an MRI study in which whole-brain maps of rCBF were...
Both mild and severe epilepsies are influenced by variants in the same genes, yet an explanation for the resulting phenotypic variation is unknown. As part of the ongoing Epi25 Collaboration, we performed a whole-exome sequencing analysis of 13,487 epilepsy-affected individuals and 15,678 control individuals. While prior Epi25 studies focused on ge...
Both mild and severe epilepsies are influenced by variants in the same genes, yet an explanation for the resulting phenotypic variation is unknown. As part of the ongoing Epi25 Collaboration, we performed a whole-exome sequencing analysis of 13,487 epilepsy-affected individuals and 15,678 control individuals. While prior Epi25 studies focused on ge...
Objective
This study aims to analyse the effect of the discontinuation of anti-calcitonin gene-related peptide antibodies on monthly migraine days after 12 treatment months.
Background
Anti-calcitonin gene-related peptide antibodies have been a game changer in migraine prophylaxis. However, high treatment costs warrant reducing treatment duration...
Objective: Patients with visual snow syndrome (VSS) suffer from continuous (“TV snow-like”) visual disturbance of unknown pathoetiology. In VSS, changes in cortical excitability in the primary visual cortex and the visual association cortex are discussed, with recent imaging studies tending to point to higher-order visual areas. Migraine, especiall...
Many studies have described the features of menstrually related migraines but there is a lack of knowledge regarding the features of migraine in combined hormonal contraceptive users (CHC). Hormone-withdrawal migraines in the pill-free period could differ from those in the natural cycle. Gynaecologic comorbidities, like dysmenorrhea and endometrios...
Here we investigate brain functional connectivity in patients with visual snow syndrome (VSS). Our main objective was to understand more about the underlying pathophysiology of this neurological syndrome. Twenty‐four patients with VSS and an equal number of gender and age‐matched healthy volunteers attended MRI sessions in which whole‐brain maps of...
Objective: The aim of this study was to collect and rate Green Flags, that is, symptoms or pieces of information indicating that a patient is more likely to suffer from a primary than from a secondary headache.
Background: When assessing headaches, a central question to be answered is whether the pain is primary or secondary to another disorder. T...
Background /aim Migraine with aura (MwA) in the emergency setting is common and sometimes difficult to distinguish from mimicking conditions. Susceptibility weighted imaging (SWI), a magnet resonance (MR) technique is sensitive to deoxygenated hemoglobin in cerebral veins and depicts these according to their level of oxygenation (1). Our study aime...
Purpose: Migraine with aura (MwA) in the emergency setting is common and sometimes difficult to distinguish from mimicking conditions. Susceptibility weighted imaging (SWI), a magnet resonance (MR) technique is sensitive to deoxygenated hemoglobin in cerebral veins and depicts these according to their level of oxygenation. Our study aimed at evalua...
Recently in the journal, epidemiological data are presented on visual snow syndrome (VSS) using a crowdsourcing online platform [1]. The authors applied criteria for VSS to a sample of people matched for age, sex, and ethnicity to United Kingdom census data. Further, they assessed frequent headache lasting longer than 4 hours, which was interpreted...
Background
Visual snow syndrome is a debilitating disorder characterized by tiny flickering dots (like TV static) in the entire visual field and a set of accompanying visual (palinopsia, enhanced entoptic phenomena, photophobia, nyctalopia), nonvisual (e.g. tinnitus) and nonperceptional (e.g. concentration problems, irritability) symptoms. Its path...
Background
Patients with visual snow syndrome (VSS) describe tiny flickering dots in the entire visual field resembling the noise of a poorly adjusted channel of analogue television with additional symptoms. Little is known about the pathophysiology and therapeutic options for this debilitating condition.
Objectives
We present a case series of thr...
Objective
This case series describes and discusses the potential clinical utility of a prominent vein (index vein) found on susceptibility-weighted MRI during migraine aura that drains the cortical area responsible for patients' symptoms.
Methods
Six patients with acute migraine aura had a prominent draining sulcal vein on emergency MRI done initi...
Patients with visual snow syndrome suffer from a continuous pan-field visual disturbance, additional visual symptoms, tinnitus, and non-perceptional symptoms. The pathophysiology of visual symptoms might involve dysfunctional visual cortex. So far, the extra-visual system has not been investigated. We aimed at identifying structural and functional...
Objective:
To investigate the pathophysiology of visual snow (VS), through a combined functional neuroimaging and magnetic resonance spectroscopy (1 H-MRS) approach.
Methods:
We applied a functional MRI block-design protocol studying the responses to a visual stimulation mimicking VS, in combination with 1 H-MRS over the right lingual gyrus, in...
Objective:
To validate the current criteria of visual snow and to describe its common phenotype using a substantial clinical database.
Methods:
We performed a web-based survey of patients with self-assessed visual snow (n = 1,104), with either the complete visual snow syndrome (n = 1,061) or visual snow without the syndrome (n = 43). We also des...
In addition to migraine, tension-type headache and cluster headache, there are several additional primary headaches. They comprise the trigeminal autonomic cephalalgias paroxysmal hemicrania, hemicrania continua and short-lasting unilateral neuralgiform headaches with autonomic symptoms, which belong to the most excruciating headaches. Some are cha...
Objective
To quantify photophobia in visual snow syndrome (VSS), a debilitating migraine-associated visual disturbance manifesting with continuous “TV snow-like” flickering dots in the entire visual field and additional visual symptoms, such as photophobia.
Methods
Photophobia was compared between 19 patients with VSS and 19 controls matched for a...
Visual snow syndrome (VSS) is a debilitating disorder characterized by continuous visual snow (VS), ie, tiny flickering dots in the entire visual field resembling the view of a badly tuned analog television (Figure), plus additional visual symptoms, such as photophobia and palinopsia. There is a high comorbidity with migraine and migraine aura.¹ To...
Lichtblitze, Zickzack-Linien und Skotome können bei Migränepatienten der eigentlichen Kopfschmerzattacke vorausgehen und sind für die Betroffenen eine zusätzliche Belastung. Unsere Autoren geben einen Überblick über diese Sehstörungen und zeigen Therapiemöglichkeiten auf.
Sequencing-based studies have identified novel risk genes associated with severe epilepsies and revealed an excess of rare deleterious variation in less-severe forms of epilepsy. To identify the shared and distinct ultra-rare genetic risk factors for different types of epilepsies, we performed a whole-exome sequencing (WES) analysis of 9,170 epilep...
Sequencing-based studies have identified novel risk genes associated with severe epilepsies and revealed an excess of rare deleterious variation in less-severe forms of epilepsy. To identify the shared and distinct ultra-rare genetic risk factors for different types of epilepsies, we performed a whole-exome sequencing (WES) analysis of 9,170 epilep...
Juvenile myoclonic epilepsy (JME) is a common syndrome of genetic generalized epilepsies (GGEs). Linkage and association studies suggest that the gene encoding the bromodomain‐containing protein 2 (BRD2) may increase risk of JME. The present methylation and association study followed up a recent report highlighting that the BRD2 promoter CpG island...
Sequencing-based studies have identified novel risk genes for rare, severe epilepsies and revealed a role of rare deleterious variation in common epilepsies. To identify the shared and distinct ultra-rare genetic risk factors for rare and common epilepsies, we performed a whole-exome sequencing (WES) analysis of 9,170 epilepsy-affected individuals...
A minority of headache patients have a secondary headache disorder. The medical literature presents and promotes red flags to increase the likelihood of identifying a secondary etiology. In this review, we aim to discuss the incidence and prevalence of secondary headaches as well as the data on sensitivity, specificity, and predictive value of red...
Background
Several previous studies have investigated cortical abnormalities, specifically cortical thickness, in patients with migraine, with variable results. The relatively small sample sizes of most previous studies may partially explain these inconsistencies.
Objective
To investigate differences of cortical thickness between control subjects...
The epilepsies affect around 65 million people worldwide and have a substantial missing heritability component. We report a genome-wide mega-analysis involving 15,212 individuals with epilepsy and 29,677 controls, which reveals 16 genome-wide significant loci, of which 11 are novel. Using various prioritization criteria, we pinpoint the 21 most lik...
Patients with visual snow syndrome (VS) suffer from a debilitating continuous visual disturbance of unknown mechanism. The present study tested the hypothesis of dysfunctional visual processing using visual evoked potentials. Eighteen patients were compared to age‐matched migraineurs (M) and healthy controls (C) using two‐way ANOVA with group (VS,...
Disorders of the brain can exhibit considerable epidemiological comorbidity and often share symptoms, provoking debate about their etiologic overlap. We quantified the genetic sharing of 25 brain disorders from genome-wide association studies of 265,218 patients and 784,643 control participants and assessed their relationship to 17 phenotypes from...
There is increasing evidence about a link between migraine, cerebral artery dissection and reversible cerebral vasoconstriction syndrome. We present a case of a patient who had all three diagnoses. The clinical evaluation of this patient was further complicated by a post-dural puncture headache, which added to the three types of headache already kn...
Primary headaches, especially migraine, are common disabling neurological disorders with recurrent headache attacks that affect approximately 12–60% of the population. Depending on headache frequency, migraine is often associated with a high socioeconomic burden and a low quality of life. In order to provide adequate treatment for severely affected...
Brainstorming diseases
Consistent classification of neuropsychiatric diseases is problematic because it can lead to misunderstanding of etiology. The Brainstorm Consortium examined multiple genome-wide association studies drawn from more than 200,000 patients for 25 brain-associated disorders and 17 phenotypes. Broadly, it appears that psychiatric...
Background:
Data on autonomic nervous system (ANS) activations in migraine patients are quite controversial, with previous studies reporting over- and underactivation of the sympathetic as well as parasympathetic nervous system. In the present study, we explicitly aimed to assess the cranial ANS in migraine patients compared to healthy controls by...
Patients with visual snow suffer from pan-field, dynamic visual disturbance. Proposed diagnostic criteria require at least two additional visual symptoms from: palinopsia, entoptic phenomena, photophobia and nyctalopia. We characterised patients’ clinical symptoms with regard to the current criteria. An online survey was prepared in collaboration w...
Patients with visual snow suffer from pan-field, dynamic visual disturbance. Proposed diagnostic criteria require at least two additional visual symptoms from: palinopsia, entoptic phenomena, photophobia and nyctalopia. Little is known regarding useful pharmacological treatments for patients. The aim of this study was to gain knowledge on the effec...
Background
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) are two rare headache syndromes classified broadly as Trigeminal Autonomic Cephalalgias (TACs).
Methods
Here, 65 SUNCT (37 males) and 37...
Purpose of review:
We provide an overview of the neurological condition known as visual snow syndrome. Patients affected by this chronic disorder suffer with a pan-field visual disturbance described as tiny flickering dots, which resemble the static noise of an untuned television.
Recent findings:
The term 'visual snow' has only appeared in the...
Headache is one of the most common ailments; migraine is one of the most prevalent and disabling neurological disorders and cluster headache presents as one of the most excruciating pain disorders. Both are complex disorder characterized by recurrent episodes of headache. A key feature is that various triggers can set off an attack providing the op...
Objective:
To evaluate the characteristics of visual auras (VA) in epilepsy and migraine.
Background:
Both disorders are usually diagnosed on clinical grounds, but differentiation might be challenging in isolated auras or because of the similar presentation in migraine and epilepsy.
Methods:
A retrospective study of two cohorts was performed t...
Kopfschmerz ist eines der häufigsten Leitsymptome für eine Vorstellung in der Notaufnahme. In diesem Artikel soll ein Algorithmus vorgestellt werden, wie in einer solchen Situation vorgegangen werden kann. Grundlage ist eine ausführliche Anamnese des aktuellen Kopfschmerzes mit besonderem Fokus auf Dynamik, Phänotyp und Triggerfaktoren sowie einer...
Plaguing humans for more than two millennia, manifest on every continent studied, and with more than one billion patients having an attack in any year, migraine stands as the sixth most common cause of disability on the planet. The pathophysiology of migraine has emerged from a historical consideration of the “humors” through mid-20th century distr...
Hemicrania continua (HC) is a primary chronic headache disorder, characterized by a continuous and strictly unilateral headache, with possible cranial autonomic symptoms during episodes of pain exacerbation. The unilateral headache generally responds well to indomethacin; however, continuous indomethacin intake is often not tolerated due to severe...
Visual disturbances in migraineurs, such as visual aura, are typically episodic, that is, associated with the headache attack, and overlaid by head pain and other symptoms that impact the patient. In some patients, however, visual symptoms are dominant due to frequency (migraine aura status), duration (persistent migraine aura and other persistent...
