A 78-year-old man presented with severe headache for 2 weeks. The headache happened suddenly, thu... more A 78-year-old man presented with severe headache for 2 weeks. The headache happened suddenly, thunderclap-like, over his vertex down to occipital region without any accompanying nausea, vomiting, phonophobia, or photophobia. The headache was described as bursting but not pulsatile and it was not related to postural change. He mentioned that his headache would worsen by exertion or other Valsalva-like maneuvers such as straining at stools or coughing. Past history included untreated hypertension and chronic obstructive pulmonary disease treated with xanthium 400 mg per day. Previously, he had also suffered an intermittent mildly tension-type headache over right temporal region for at least 4 years before this episode. This type of headache was controlled by over-the-counters or non-steroidal anti-inflammatory agents. On admission, neurological examination results were normal without papilledema or neck rigidity. Because his headache was very intense and characterized by acute-onset, ...
Journal of the Chinese Medical Association : JCMA, Jan 10, 2016
Theta burst stimulation is a type of pattern-specific repetitive transcranial magnetic stimulatio... more Theta burst stimulation is a type of pattern-specific repetitive transcranial magnetic stimulation that requires less stimulation time and lower intensity to induce long-lasting effects comparable to those of other repetitive transcranial magnetic stimulation protocols. This pilot study investigated whether continuous theta burst stimulation (cTBS) on the primary motor cortex reduced headache frequency in patients with migraine. Nine patients with migraine were recruited into our study. All patients received 20 cTBS sessions (bursts of 3 50-Hz TMS pulses at 200-ms intervals for 40Â seconds), administered every weekday for 4 consecutive weeks. All patients kept headache diaries for 4Â weeks before stimulation (baseline; T1), during stimulation (T2), and 4Â weeks after stimulation (T3). The primary outcome measures were the changes of total headache and migraine days from baseline (Wilcoxon signed-rank test; T2 and T3 vs. T1). The number of total headache days was reduced at T2 and T3 co...
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADAS... more Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is originally featured with a strong clustering of mutations in NOTCH3 exons 3-6 and leukoencephalopathy with frequent anterior temporal pole involvement. The present study aims at characterizing the genotypic and phenotypic profiles of CADASIL in Taiwan. One hundred and twelve patients with CADASIL from 95 families of Chinese descents in Taiwan were identified by Sanger sequencing of exons 2 to 24 of NOTCH3. Twenty different mutations in NOTCH3 were uncovered, including 3 novel ones, and R544C in exon 11 was the most common mutation, accounting for 70.5% of the pedigrees. Haplotype analyses were conducted in 14 families harboring NOTCH3 R544C mutation and demonstrated a common haplotype linked to NOTCH3 R544C at loci D19S929 and D19S411. Comparing with CADASIL in most Caucasian populations, CADASIL in Taiwan has several distinct features, including less frequent anterior temporal in...
Background Researches to date on the association between headache and weather have yielded incons... more Background Researches to date on the association between headache and weather have yielded inconsistent results. Only a limited number of studies have examined the clinical significance of self-reported weather sensitivity. This study aimed to identify the difference in the association of headache with temperature between migraine patients with and without temperature sensitivity. Methods 66 migraine patients (75.8 % female; mean age 43.3 ± 12.9 years) provided their 1-year headache diaries from 2007 to a headache clinic in Taipei, Taiwan. 34 patients (51.5 %) reported sensitivity to temperature change but 32 (48.5 %) did not. Time series of daily headache incidence was modeled and stratified by temperature sensitivity. Empirical mode decomposition was used to identify temporal weather patterns that were correlated to headache incidence, and regression analysis was used to examine the amount of variance in headache incidence that could be explained by temperature in different season...
Autonomic imbalance may play an important role in the pathogenesis of reversible cerebral vasocon... more Autonomic imbalance may play an important role in the pathogenesis of reversible cerebral vasoconstriction syndromes (RCVS). This study aimed to assess the autonomic function by analyzing heart rate variability (HRV) in patients with RCVS. Patients with RCVS and age- and gender-matched controls were consecutively recruited. All patients (both ictal and remission stage) and controls underwent 24-hour ambulatory electrocardiographic (ECG) recordings. HRV measures covering time and frequency domains were used to assess autonomic functioning. Thirty-nine patients with RCVS and 39 controls completed the study. Compared to the controls, RCVS patients during the ictal stage showed reductions in parasympathetic-related indices, including the root mean square of difference of consecutive interbeat intervals (RMSSD) (22.1 ± 7.0 vs. 35.2 ± 14.2, p < 0.001), the percentage of adjacent intervals that varied by more than 50 ms (pNN50) (3.7 ± 3.4 vs. 10.6 ± 8.1, p < 0.001), and high-frequenc...
Migraine is a recurring and disabling pain disorder. The prevalence is estimated as 9.1% in Taiwa... more Migraine is a recurring and disabling pain disorder. The prevalence is estimated as 9.1% in Taiwan. Patients suffer from significant loss of work, time at school or ability to perform household chores, as well as other family or leisure activities. Treatment strategies during migraine attacks should be tailored based on the severity of disability. Stewart and Lipton (1999) developed the Migraine Disability Assessment Questionnaire (MIDAS) to assess the severity of disability related to migraine. This simple, self-administered, 7-item questionnaire focuses on disability in three domains (school or paid work, household chores, and family, social, or leisure activities) in the first 5 items of the questionnaire. The internal consistency, test-retest reliability, validity, ease of use, and clinical utility were all tested with good results. The questionnaire offers a simple tool to improve physician-patient communication. As for treatment strategies, a recent large-scale study done in t...
A 78-year-old man presented with severe headache for 2 weeks. The headache happened suddenly, thu... more A 78-year-old man presented with severe headache for 2 weeks. The headache happened suddenly, thunderclap-like, over his vertex down to occipital region without any accompanying nausea, vomiting, phonophobia, or photophobia. The headache was described as bursting but not pulsatile and it was not related to postural change. He mentioned that his headache would worsen by exertion or other Valsalva-like maneuvers such as straining at stools or coughing. Past history included untreated hypertension and chronic obstructive pulmonary disease treated with xanthium 400 mg per day. Previously, he had also suffered an intermittent mildly tension-type headache over right temporal region for at least 4 years before this episode. This type of headache was controlled by over-the-counters or non-steroidal anti-inflammatory agents. On admission, neurological examination results were normal without papilledema or neck rigidity. Because his headache was very intense and characterized by acute-onset, ...
Journal of the Chinese Medical Association : JCMA, Jan 10, 2016
Theta burst stimulation is a type of pattern-specific repetitive transcranial magnetic stimulatio... more Theta burst stimulation is a type of pattern-specific repetitive transcranial magnetic stimulation that requires less stimulation time and lower intensity to induce long-lasting effects comparable to those of other repetitive transcranial magnetic stimulation protocols. This pilot study investigated whether continuous theta burst stimulation (cTBS) on the primary motor cortex reduced headache frequency in patients with migraine. Nine patients with migraine were recruited into our study. All patients received 20 cTBS sessions (bursts of 3 50-Hz TMS pulses at 200-ms intervals for 40Â seconds), administered every weekday for 4 consecutive weeks. All patients kept headache diaries for 4Â weeks before stimulation (baseline; T1), during stimulation (T2), and 4Â weeks after stimulation (T3). The primary outcome measures were the changes of total headache and migraine days from baseline (Wilcoxon signed-rank test; T2 and T3 vs. T1). The number of total headache days was reduced at T2 and T3 co...
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADAS... more Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is originally featured with a strong clustering of mutations in NOTCH3 exons 3-6 and leukoencephalopathy with frequent anterior temporal pole involvement. The present study aims at characterizing the genotypic and phenotypic profiles of CADASIL in Taiwan. One hundred and twelve patients with CADASIL from 95 families of Chinese descents in Taiwan were identified by Sanger sequencing of exons 2 to 24 of NOTCH3. Twenty different mutations in NOTCH3 were uncovered, including 3 novel ones, and R544C in exon 11 was the most common mutation, accounting for 70.5% of the pedigrees. Haplotype analyses were conducted in 14 families harboring NOTCH3 R544C mutation and demonstrated a common haplotype linked to NOTCH3 R544C at loci D19S929 and D19S411. Comparing with CADASIL in most Caucasian populations, CADASIL in Taiwan has several distinct features, including less frequent anterior temporal in...
Background Researches to date on the association between headache and weather have yielded incons... more Background Researches to date on the association between headache and weather have yielded inconsistent results. Only a limited number of studies have examined the clinical significance of self-reported weather sensitivity. This study aimed to identify the difference in the association of headache with temperature between migraine patients with and without temperature sensitivity. Methods 66 migraine patients (75.8 % female; mean age 43.3 ± 12.9 years) provided their 1-year headache diaries from 2007 to a headache clinic in Taipei, Taiwan. 34 patients (51.5 %) reported sensitivity to temperature change but 32 (48.5 %) did not. Time series of daily headache incidence was modeled and stratified by temperature sensitivity. Empirical mode decomposition was used to identify temporal weather patterns that were correlated to headache incidence, and regression analysis was used to examine the amount of variance in headache incidence that could be explained by temperature in different season...
Autonomic imbalance may play an important role in the pathogenesis of reversible cerebral vasocon... more Autonomic imbalance may play an important role in the pathogenesis of reversible cerebral vasoconstriction syndromes (RCVS). This study aimed to assess the autonomic function by analyzing heart rate variability (HRV) in patients with RCVS. Patients with RCVS and age- and gender-matched controls were consecutively recruited. All patients (both ictal and remission stage) and controls underwent 24-hour ambulatory electrocardiographic (ECG) recordings. HRV measures covering time and frequency domains were used to assess autonomic functioning. Thirty-nine patients with RCVS and 39 controls completed the study. Compared to the controls, RCVS patients during the ictal stage showed reductions in parasympathetic-related indices, including the root mean square of difference of consecutive interbeat intervals (RMSSD) (22.1 ± 7.0 vs. 35.2 ± 14.2, p < 0.001), the percentage of adjacent intervals that varied by more than 50 ms (pNN50) (3.7 ± 3.4 vs. 10.6 ± 8.1, p < 0.001), and high-frequenc...
Migraine is a recurring and disabling pain disorder. The prevalence is estimated as 9.1% in Taiwa... more Migraine is a recurring and disabling pain disorder. The prevalence is estimated as 9.1% in Taiwan. Patients suffer from significant loss of work, time at school or ability to perform household chores, as well as other family or leisure activities. Treatment strategies during migraine attacks should be tailored based on the severity of disability. Stewart and Lipton (1999) developed the Migraine Disability Assessment Questionnaire (MIDAS) to assess the severity of disability related to migraine. This simple, self-administered, 7-item questionnaire focuses on disability in three domains (school or paid work, household chores, and family, social, or leisure activities) in the first 5 items of the questionnaire. The internal consistency, test-retest reliability, validity, ease of use, and clinical utility were all tested with good results. The questionnaire offers a simple tool to improve physician-patient communication. As for treatment strategies, a recent large-scale study done in t...
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