Mansoureh Togha

Tehran University of Medical Sciences | TUMS · Neurology, Sina, Hospital

Migraine headaches are the most prevalent disabling primary headaches, affecting individuals at an active age. Dietary interventions are considered low-cost and practical approaches to migraine prophylaxis. Hence, the present study aimed to assess the association between adherence to the Healthy Eating Index 2015 (HEI-2015) and migraine headaches....

Key Clinical Message Although increasing in number, cases of CVS are being frequently misdiagnosed and many are refractory to the available treatments. This paper draws attention to a timely consideration of this disorder upon suspicion and proposes rectal diazepam and cinnarizine as highly effective treatments in refractory cases of CVS. Abstract...

Background Tension-Type Headache (TTH) is regarded as the third most prevalent disorder worldwide, prompting children to seek medical attention. Our objective is to investigate the prevalence of TTH among students aged 6 to 18 years in various geographical regions of Iran, while also assessing the impact of headaches on their quality of life. Meth...

Background: Neck pain is a common complaint among migraineurs possibly due to the anatomic connections between cervical and trigeminal afferents in the trigeminocervical complex (TCC). Manual therapy (MT) is used in the management of headache disorders, with demonstrable neurophysiological effects. The blink reflex (BR) is one method of analyzing...

Background: Little is known about the association between dietary patterns and odds of migraine. We aimed to investigate the association between posteriori dietary patterns and migraine odds and migraine-related outcomes using principal component analysis (PCA). Methods: A total of 500 participants enrolled in this age- and sex-matched case-control...

Background Headache is the most frequent neurological adverse event following SARS-CoV-2 vaccines. We investigated the frequency, characteristics, and factors associated with post-vaccination headaches, including their occurrence and prolongation (≥ 48 h). Methods In this observational cross-sectional cohort study, retrospective data collected bet...

The quality of clinical trials is essential to advance treatment, inform regulatory decisions and meta-analysis. With the increased incidence of idiopathic intracranial hypertension and the emergence of clinical trials for novel therapies in this condition, the International Headache Society Guidelines for Controlled Clinical Trials in Idiopathic I...

Background: This multicenter cross-sectional study aimed to determine the frequency and characteristics of secondary headaches in different geographic regions, including Turkey, the Middle East, Asia, and Africa. Methods: Patients were admitted to the study on a particular day each week for five consecutive weeks between 1 April and 16 May 2022....

Introduction: Headache worsening has been previously reported following the coronavirus disease 2019 (COVID-19) vaccination. However, COVID vaccination's influence on managing chronic migraine (CM) with botulinum toxin is yet to be studied. Case Presentation: In this case series, we present five cases of CM, who had responded to abobotulinum toxin...

Background There is evidence of the occurrence of headache after vaccination against COVID-19. However, only a few studies have examined the headache characteristics and related determinants, especially among healthcare workers with a history of COVID-19 infection. Methods We evaluated the incidence of headaches after injection of different types...

Objectives Migraine is a common, multifactorial disorder. The exact pathomechanism of migraine remains unclear. Studies have revealed changes in serum prolactin (PRL) levels in relation to migraine, although the results have been inconsistent. The present case‐control study assessed the serum level of prolactin in migraine patients. Materials and...

OBJECTIVE: Describe the coronavirus disease of 2019 (COVID-19) vaccine-related headache characteristics. Determine factors associated with developing headaches and factors related to prolonged headaches (≥ 48h) among COVID-19 vaccine receivers. BACKGROUND: Vaccines are the safest tools for preventing COVID-19-related morbidity/mortality. Headaches...

Abstract Background Headaches are frequent neurological disorders that are yet to be unveiled and treated comprehensively worldwide. Bearing in mind that the distribution of headache subtypes in neurology clinics (NC) is essential for planning appropriate diagnostic and therapeutic approaches, the primary goals of this multi-centric study are to ca...

Background: There is evidence of the occurrence of headache after vaccination against COVID-19. However, only a few studies have examined the headache characteristics and related determinants, especially among healthcare workers with a history of COVID-19 infection. Methods: We evaluated the incidence of headaches after injection of different types...

Background Migraine is commonly linked to a range of psychiatric comorbidities, primarily anxiety and depression. The present study compared the frequency of anxiety and depression disorders in migraine and non-migraine adolescents and evaluated the relation of depression and anxiety to migraine characteristics. Methods In this case-control study,...

Abstract Background Several inflammatory and vascular molecules, and neurotrophins have been suggested to have a possible role in the development of migraine. However, pathophysiological events leading to migraine onset and transformation of episodic migraine (EM) to chronic migraine (CM) are not fully understood. Thus, we aimed to assess periphera...

Migraine is a highly prevalent disorder with an enormous burden on societies. Different types of medications are used for controlling both acute attacks and prevention. This article reviews some non-pharmacological recommendations aiming to manage migraine disorder better and prevent headache attacks. Different triggers of migraine headache attacks...

Background: The B vitamins can potentially help prevent migraine. This study was designed to examine the effects of supplementation with thiamine (B1), pyridoxine (B6), cobalamin (B12), folic acid (B9), and a combination of these vitamins on women with episodic migraine (EM). Methods: This study was a double-blind, placebo-controlled, randomized, c...

Background There is increasing evidence that some biomarkers are implicated in migraine pathogenesis. This study looks at plasma proteome in migraine patients for potential protein biomarkers. Methods This case-control study has two phases. In phase I, plasma samples were collected from three groups, including twenty-three episodic migraineurs, th...

Objective Since the beginning of the COVID-19 pandemic, a number of COVID-related neurological manifestations have been reported. We aimed to categorize the features of hospitalized COVID-19 patients who experienced neurological symptoms.Methods In this descriptive, cross-sectional study, we enrolled all patients hospitalized with COVID-19 who expe...

Background: This study investigated the effect of Valsalva maneuver (VM) on migraine headache (MH).

Since December 2019, the time when the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was spotted, numerous review studies have been published on COVID-19 and its neuro invasion. A growing number of studies have reported headaches as a common neurological manifestation of COVID-19. Although several hypotheses have been proposed regard...

Background While the Global Burden of Disease study reports headache disorders as the third-highest cause of disability worldwide, the headache data in this study largely come from adults. This national study in Iran, the first of its type in the Eastern Mediterranean Region, was part of a global schools-based programme within the Global Campaign a...

Headache is a known complication of the pituitary lesion. Different treatment methods such as surgery and radio-surgery used to treat these tumors, there are some reports of patients in whom preoperative headaches still exist after surgery or de novo postoperative headache started. Here we report 4 cases of headaches under vented transsphenoidal su...

Objective Withdrawal of the overused drugs in medication overuse headache (MOH) can contribute to severe rebound headache and many other symptoms. In this regard, some centers perform bridge therapy during the days of withdrawal to manage the rebound headache and withdrawal symptoms resulting from the discontinuation of the offending drug. To inves...

Background Although headache is a common complaint in younger individuals, it is one of the most common complaints among persons over the age of 50 and is a significant cause of morbidity. As there are differences in the causes and types of headache, the diagnosis and management of headache in older adults differ from that in younger individuals....

Background: Spontaneous intracranial hypotension (SIH) is a secondary headache that has been attributed to a cerebrospinal fluid (CSF) leak. It may resolve spontaneously or require conservative treatment. An epidural blood patch (EBP) with autologous blood is performed in cases exhibiting an inadequate response to conservative methods. Rebound int...

Purpose of Review The lifetime prevalence of headaches is 96%. Approximately 11% of the adult population worldwide has a migraine headache. Migraine is a complex disorder that is more than a simple headache. So far, many underlying mechanisms, i.e. inflammatory, vascular, neurogenic have been hypothesized. In recent years evidences proposed that an...

Background: There is strong evidence of headaches following COVID-19 vaccination using any type of vaccine. However, very few studies have examined the headache characteristics and their determinants, especially among healthcare employees who have previously experienced COVID-19 infection. We evaluated and compared the incidence of headache followi...

Objective: Migraine is recognized as a disease with unknown etiology and various pathophysiologic pathways which are not fully understood. Due to the relation between dairy intake and various chronic conditions in children and also the paucity of data on the probable role of dairy intake on pediatrics' odds of having migraine, this study was desig...

Migraine headaches are disabling conditions, especially in young adults. Correct diagnosis, the choice of medication to control headache attacks, and appropriate prophylactic treatment when implicated can help to decrease the burden of the disease. Differences in migraine characteristics in children and migraine attacks accompanied by autonomic sym...

Headache is a common neurologic manifestation of COVID-19 that usually has benign features and has been considered as a good prognostic factor. However, occasionally such symptoms could be due to a serious cause such as cerebral venous sinus thrombosis or meningitis/encephalitis. The activation of the trigeminovascular system has been proposed as a...

Objectives: This study aimed to investigate the role of serum levels of transient receptor potential cation channel subfamily V member 1 (TRPV1), vasoacive intestinal peptide (VIP), and pituitary adenylate cyclase-activating polypeptide (PACAP) in the development and also the transformation of migraine in patients suffering from migraine. Methods:...

Background Cranial autonomic symptoms are common in migraine, with eye redness and tearing being the most common ones. Their identification can help to avoid misdiagnosis, predict the disease course, and select the appropriate treatment. Methods This was a cross-sectional study of 904 patients who presented with migraine to a headache referral cli...

Background Reversible Cerebral Vasoconstriction Syndrome is a condition of transient cerebral vascular spasms, which usually presents with recurrent thunderclap headaches and recovers within 3 months. Several probable triggers and underlying factors, such as sex hormones, vasoactive drugs, head trauma or surgery, and tumors, have been implicated....

In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primar...

Background There is limited evidence about visceral autonomic symptoms in the different phases of migraine attack. We evaluated the prevalence of these symptoms in migraineurs before, during, and after headache attacks. In addition, the association between migraine characteristics and visceral autonomic symptoms was investigated. Methods A total o...

Background The COVID‐19 pandemic has created new conditions for medical staff, forcing them to use personal protective equipment (PPE) for an extended duration of time. Headache is a commonly associated side effect of the use of such equipment among healthcare workers. Method In this cross‐sectional study, 243 frontline healthcare workers at four...

Background Without an adequate immune response, SARS-CoV2 virus can simply spread throughout the body of the host. Two of the well-known immunonutrients are selenium (Se) and zinc (Zn). Se and Zn deficiency might lead to inflammation, oxidative stress, and viral entry into the cells by decreasing ACE-2 expression; three factors that are proposed to...

Introduction There are increasing demands for studies of cost-effectiveness to allocate resources for disease prevention and treatment strategies. The aim of this study is to measure quality of life in migraineurs, based on the Migraine-Specific Questionnaire (MSQ) and EQ-5D-5L, and thereafter map an algorithm to estimate health-state utility value...

Background: Generalized anxiety disorder (GAD) often remains undiagnosed in patients with migraine, while comorbidity of GAD with migraine is associated with increased dysfunction and risk of chronic migraine. Generalized Anxiety Disorder Scale 7-item (GAD-7) and Generalized Anxiety Disorder Scale 2-item (GAD-2) are the commonly employed scr...

Background: Migraine is considered the most common cause of long-term disability in under-50s, which can lead to unbearable pain and neurological dysfunction. Many factors, especially dietary factors, are suggested to trigger migraine headaches. The present study aimed to examine the association between diet-dependent acid load and severity and dur...

Background: Spontaneous intracranial hypotension (SIH) is a secondary headache that has been attributed to a cerebrospinal fluid (CSF) leak. It may resolve spontaneously or require conservative treatment. An epidural blood patch (EBP) with autologous blood is performed in cases exhibiting an inadequate response to conservative methods. Rebound intr...

Trigeminal Autonomic Cephalalgias (TAC) are excruciating headaches with limited treatment options. The chronic forms of TACs, including chronic cluster, chronic paroxysmal hemicrania, and hemicrania continua, are disabling conditions. In addition to drug therapy, there are some studies regarding nerve blocking and nerve stimulation with acceptable...

Background: Migraine is a chronic medical problem and sometimes progressive disorder characterized by recurrent episodes of headache. Nutritional factors can reduce and prevent the severity and frequency of migraine. Objectives: This study aimed to assess the relationship between major dietary patterns and disease severity among migraine patients....

Introduction: It has been shown that a high acid load in the human body can affect inflammatory factors and the nitric oxide pathway. These factors are also thought to play an important role in the initiation of migraine attacks. We have therefore explored the association between dietary acid load and odds of migraine in a case-control study. Met...

Background: Migraine is a recurrent disorder which can cause socio-economic and public health burdens. Many factors, especially dietary factors are suggested to induce migraine headaches. The aim of this study was to examine the association between plant-based dietary patterns and headache severity and duration among migraine patients. Methods: A s...

Background Although the exact mechanism involved in migraine pathogenesis remained uncertain, and different researches have been developed to address the role of neuroinflammation and immune dysfunction. Therefore, considering the immune protective functions of vitamin D3, we aimed to investigate the effects of daily administration of 2000 IU D3 su...

Background: Among multiple sclerosis (MS) related symptoms and complications, fatigue might impact roughly 90% of patients. Decline in cognitive function is one of the other complications that occur in the first years after disease onset. The Mediterranean diet is one of the well-known anti-inflammatory dietary approaches. Therefore, this study aim...

Introduction: Tension type headache is the most common type of headache that is associated with myofascial pain syndrome and trigger points. The aim of this study was to evaluate the efficacy of deep dry needling into trigger points of temporalis, sternocleidomastoid and upper trapezius muscles of females with episodic tension type headache. Materi...

Background Reversible Cerebral Vasoconstriction Syndrome is a condition of transient cerebral vascular spasms presenting with recurrent thunderclap headaches and recovery within three months. Several probable triggers and underlying factors, such as sex hormones, vasoactive drugs, head trauma or surgery, and tumors, have been implicated. Case prese...

In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primar...

Background: Headache is among the most common disabling neurologic disorders. We measured quality of life in chronic migraine (CM) and episodic migraine (EM), stratified by medication overuse headache (MOH) and presence of aura. Methods: In this observational study, conducted from January 2016 to December 2018, adult patients referred to the tertia...

Background and objectives: Migraine is a predominant headache condition with frequent, sporadic attacks of moderate to severe pain. Modifying dietary habits have been considered as an appropriate therapeutic approach in these patients. This study was designed to examine the association between dietary diversity score (DDS) and severity, frequency...

Background and objective: Medication-overuse headache (MOH) as a secondary chronic headache imposes a considerable burden on both individuals and societies. Nevertheless, little is known about the burden of MOH in Iran. Therefore, in the current study, we aimed to quantify the annual cost of MOH among Iranian patients. Methods: In this cross-sec...

Background: According to previous evidence, it has been shown that high acidic load in human body could affect inflammatory factors and the nitric oxide pathway. On the other hand, these factors are thought to play a role in initiation of migraine attacks. Therefore, we aimed to explore the association between dietary acid load and the odds of migr...

Background: Migraine is a neurologic disorder. Although, based on previous evidence, migraine is related with inflammation and oxidative stress, its relationship with the inflammatory potential of the diet is still unknown. Thus, the aim of this study was to show the correlation between Dietary Inflammatory Index (DII) and severity and duration of...

Introduction Despite the available prophylactic and acute drugs for migraine management, this disabling disorder remains undertreated especially among pediatrics. In this review, the authors aim at assessing the preventive role cinnarizine plays in treating migraine based on previously published studies. Areas Covered Randomized clinical trials, r...

Background: B-group vitamins can potentially contribute to migraine prophylaxis through various mechanisms. We conducted a quasi-experimental study to assess the efficacy and tolerability of a combination of vitamins B1, B6, and B12 (Neurobion) for prophylaxis of menstruation-related migraine attacks. Methods: Women diagnosed with menstrual-related...

Due to inconclusive findings of previous researches, we aimed to evaluate inflammatory state biomarkers in episodic and chronic migraineurs (EM and CM patients) compared to headache-free controls in the current study. Seventy-one migraine patients and 19 age-sex-matched controls were recruited. After obtaining demographic data and recording headach...

Objectives Migraine is a common type of headaches and disabling disorder. Based on evidences dehydration is closely related to promote migraine headcahe frequency and severity. The Water intake is the best intervention to reduce or prevent headache pain. water intake in migraine patients has rarely been studied. the present study aimed to evaluate...

The aim of the current study was to assess the risk factors, clinical symptoms and Cerebrospinal fluid (CSF) pressure of idiopathic intracranial hypertension (IIH) with emphasis on determining the risk factors which involved in poor response to treatment. We retrospectively included 202 patients who were diagnosed with IIH. Disease severity was cla...

Background: Emerging evidence showed promising effects of vitamin D on headaches characteristics. Thus, it seems there is still a need for more researches to clarify the mechanisms by which this vitamin exerts anti-migraine effects. Methods: The present study was conducted as a 16-week randomized double-blind placebo-controlled trial on 80 episo...

The terminology "gut-brain axis "points out a bidirectional relationship between the GI system and the central nervous system (CNS). To date, several researches have shown that migraine is associated with some gastrointestinal (GI) disorders such as Helicobacter pylori (HP) infection, irritable bowel syndrome (IBS), and celiac disease (CD). The pre...

Introduction: Due to anti-inflammatory effects of vitamin D3, we aimed to explore the effects of supplementation with this vitamin on headache characteristics and serum levels of pro/anti-inflammatory markers in migraineurs. Methods and materials: This placebo-controlled, double-blind study included 80 episodic migraineurs who randomly assigned...

Background: Migraine is a neurological disorder which can threaten public health and cause socioeconomic burdens. Dietary factors are proposed to be associated with migraine pain. The aim of this study was to examine the association between Dietary Phytochemical Index (DPI) and headache severity and duration among migraine patients. Methods: A samp...

Abstract Background In recent years, the role of neuroinflammation and oxidative stress in migraine pathogenesis has achieved considerable interest; however, to date findings are equivocal. Thus, the objective of this study was to investigate biomarkers of oxidative stress in episodic and chronic migraineurs (EM and CM patients) and controls. Metho...

Background: Cervicogenic headache (CeH) is among the common types of headache which has an undesirable influence on the quality of life. The myofascial trigger point (MTrP) within the sternocleidomastoid (SCM) muscle is one of the most important causes of CeH. Objective: The purpose of this study was to compare the effect of dry needling (DN) an...

Purpose Diet is recognized as a possible potential factor in migraine pathogenesis. Limited evidence exists on the effect of diet on pediatric migraine, so this paper aims to investigate the association between fruit and vegetable consumption and odds of migraine in children. Design/methodology/approach The authors conducted a case-control study i...

The global prevalence of migraine as a primary headache has been estimated as 14.4% in both sexes. Migraine headache has been ranked as the highest contributor to disability in under 50 years old population in the world. Extensive research has been conducted in order to clarify the pathological mechanisms of migraine. Although uncertainties remains...

Background Few migraine preventive agents have been assessed in a pediatric population. We evaluated the safety and efficacy of cinnarizine and sodium valproate for migraine prophylaxis in children and adolescents. Methods We carried out a randomized double-blind placebo-controlled trial in the Children’s Medical Center and Sina hospital, Tehran,...

This article is a Letter to the Editor and does not include an Abstract.

Background: Migraine is a debilitating neurological disorder with a high prevalence. This study was conducted to evaluate the relationship between body mass index (BMI) and disability, severity, frequency and duration of headaches in female migraine patients. Methods: This cross-sectional study was designed to address the characteristics of migr...

Background: Although the exact pathophysiological mechanistic pathways that result in the initiation of migraine attacks remain unclear, there are some proposed mechanisms including neurogenic inflammation, trigeminovascular system activation, vascular dysfunction, and augmented release of nitric oxide (NO) and homocysteine (Hcy). Vitamin B12 is t...

Introduction As a primary headache, migraine has been established as the first leading disability cause worldwide in the subjects who aged less than 50 years. A variety of dietary supplements have been introduced for migraine complementary treatment. As an anti-inflammatory and antioxidant agent, vitamin D is one of these agents which has been of i...

Migraineurs have been identified to have chronically decreased serotonin levels while its concentrations markedly increase during ictal periods. Regarding the importance of adequate tryptophan intake in regulating serotonin homeostasis and subsequent effect on migraine attacks, we designed the current study. The migraine group (n = 514, diagnosed a...

It remains unknown whether migraine headache has a progressive component in its pathophysiology. Quantitative MRI may provide valuable insight into abnormal changes in the migraine interictum and assist in identifying disrupted brain networks. We carried out a data-driven study of structural integrity and functional connectivity of the resting brai...

Background: The current study was designed to assess the effect of supplementation with a 14-strain probiotic mixture on episodic and chronic migraine characteristics. Methods: Forty episodic and 39 chronic migraine patients who completed this randomized double-blind controlled trial received two capsules of multispecies probiotic or placebo. Th...

Objective: Neuroinflammatory disease is a general term used to denote the progressive loss of neuronal function or structure. Many neuroinflammatory diseases, including Alzheimer's, Parkinson's, and multiple sclerosis (MS), occur due to neuroinflammation. Neuroinflammation increases nuclear factor-κB (NF-κB) levels, cyclooxygenase-2 enzymes and in...

Introduction: Converging evidence suggests that both emotional and cognitive processes are critically involved in moral judgment, and may be mediated by discrete parts of the prefrontal cortex. The current study aimed at investigating the mediatory effect of right Frontopolar Cortex (rFPC) on the way that emotions affect moral judgments. Methods:...

Objective The association between serum vitamin D and migraine is investigated in this research.s Background Although the pathogenesis of migraine headache is not fully understood, the possible role of inflammation and disturbed immune system has been proposed; thus, higher levels of vitamin D might reduce the risk of migraine. However, the result...

Background: Idiopathic intracranial hypertension (IIH) encompasses patients with elevated intracranial pressure (ICP). Generally, it is difficult to make a differential diagnosis between IIH and co-existing migraine headaches. Thus, this article intends to estimate the prevalence of migraine in patients with IIH and explain the occurrence of new-on...

Purpose/introduction: Migraine is a common disorder, with attacks causing neurological dysfunction and pain. Many foods are involved in reducing the severity of migraine attacks. This study aimed to assess the effects that adhering to the Dietary approaches to stop hypertension (DASH) diet had on headache severity and duration among women suffering...

The exact mechanism of the migraine pathophysiology remained unclear. Although there are some reports showing low-grade inflammation in migraineurs, further studies are needed in this field. Thus, we designed a study to evaluate the serum levels of two main proinflammatory markers in migraine patients. In this case-control research, 43 migraine pat...

Background: Since most patients with relapsing-remitting multiple sclerosis (RRMS) are women, the present study aimed to determine whether treatment of patients with MS by cytotoxic agents is associated with an increased risk of cervical dysplasia. Cancer screening is often neglected in the chronic diseases such as MS, so more attention in this fie...