bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advances in the Understanding of Pathophysiology of TTH and its Management
Authors: Bhoi Sanjeev K , Jha Menka , Chowdhury Debashish 
Published: May 2021

Background:
Tension-type headache (TTH) is the most common form of primary headache.

Objective:
The aim of this study was to document and summarize the advances in the understanding of TTH in terms of pathogenesis and management.

Material and Methods:
We reviewed the available literature on the pathogenesis and management of TTH by searches of PubMed between 1969 and October 2020, and references from relevant articles. The search terms “tension-type headache”, “episodic tension-type headache”, chronic tension-type headache, “pathophysiology”, and “treatment” were used.

Results:
TTH occurs in two forms: episodic TTH (ETTH) and chronic TTH (CTTH). Unlike chronic migraine, CTTH has been less thoroughly studied and is a more difficult headache to treat. Frequent ETTH and CTTH are associated with significant disability. The pathogenesis of TTH is multifactorial and varies between the subtypes. Peripheral mechanism (myofascial nociception) and environmental factors are possibly more important in ETTH, whereas genetic and central factors (sensitization and inadequate endogenous pain control) may play a significant role in the chronic variety. The treatment of TTH consists of pharmacologic and non-pharmacologic approaches. Simple analgesics like NSAIDs are the mainstays for acute management of ETTH. CTTH requires a multimodal approach. Preventive drugs like amitriptyline or mirtazapine and non-pharmacologic measures like relaxation and stress management techniques and physical therapies are often combined. Despite these measures, the outcome remains unsatisfactory in many patients.

Conclusion:
There is clearly an urgent need to understand the pathophysiology and improve the management of TTH patients, especially the chronic form.
Biomarkers in Migraine
Authors: Yan Brian M , Gibson Depoy E M , Ahmad Ayesha , Nahas Stephanie J 
Published: May 2021

Background:
Disability from migraine has a profound impact on the world's economy. Research has been ongoing to identify biomarkers to aid in diagnosis and treatment.

Objective:
The aim of this study was to highlight the purported diagnostic and therapeutic migraine biomarkers and their role in precision medicine.

Methods:
A comprehensive literature search was conducted using PubMed, Google Scholar, and clinicaltrials.gov using keywords: “migraine” OR “headache” combined with “biomarkers” OR “marker.” Other keywords included “serum,” “cerebral spinal fluid,” “inflammatory,” and “neuroimaging.”

Results:
After a review of 88 papers, we find the literature supports numerous biomarkers in the diagnosis of migraine. Therapeutic biomarkers, while not as extensively published, highlight calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating peptide-38 (PACAP-38) as biomarkers with the most substantiated clinical relevance. Genetic markers mainly focusing on gene mutations with resultant biochemical alterations continue to be studied and show promise.

Conclusion:
Although there are several proposed biomarkers for migraine, continued research is needed to substantiate their role in clinical practice.
Emerging Targets for Migraine Treatment
Authors: Moreno-Ajona David , Villar-Martínez María Dolores , Goadsby Peter James 
Published: May 2021

Background:
While understanding the pathophysiology of migraine has led to CGRP-based treatments, other potential targets have also been implicated in migraine.

Objectives:
To catalog new promising targets for the treatment of migraine.

Methods:
We completed a literature review focusing on 5HT1F, PACAP, melatonin, and orexins.

Results:
The 5HT1F receptor agonist lasmiditan, following two positive randomized placebo-controlled trials, was FDA-approved for the acute treatment of migraine. PACAP-38 has shown analogous evidence to what was obtained for CGRP with its localization in key structures, provocation tests, and positive studies when antagonizing its receptor in animal models, although a PAC-1 receptor monoclonal antibody study was negative. Melatonin has undergone several randomized controlled trials showing a positive trend. Filorexant is the only dual orexin receptor antagonist, which was tested in humans with negative results.

Conclusions:
Further and ongoing studies will determine the utility of these new therapies with lasmiditan and melatonin having demonstrated efficacy for the treatment of migraine.
Ditans vs Gepants
Authors: Singh Alok , Gupta Dhyuti , Singh Abhishek 
Published: May 2021

Background:
An acute attack of migraine, incapacitates the migraineurs, and is widely prevalent. And to warden off its symptoms, recently two groups of drugs have been approved and launched.

Objective:
The aim of this systematic review and indirect meta-analysis is to evaluate and summarize the effectiveness of these pharmacological interventions in managing the aforesaid disease.

Material and Methods:
An extensive literature search was done through Cochrane library, Pub Med, clincialtrials.gov, for a period of 5 years (2015–2020), using key words: lasmiditan; ubrogepant; rimegepant; and acute migraine. Randomized double-blind phase III clinical trials, published in English language, were included which explored the efficacy and safety of these drugs. The outcomes of this meta-analysis included proportion of patients' headache, most bothersome symptoms free, and no disability at all at 2 h post-dose, with sustained pain freedom 2-24 h, and experiencing any adverse event. An indirect network meta-analysis was also conducted to determine the comparative effectiveness of these drugs.

Results:
A total of seven RCTs involving 7266 patients were included. In general, the new drugs demonstrated better result in all the efficacy parameters. The adverse events were observed in treatment group compared to placebo. While in the indirect comparison, lasmiditan emerged to be superior in all the outcomes, except for sustained pain freedom 2-24 h (rimegepant was better). The adverse events were more with lasmiditan.

Conclusion:
All the newer drugs have shown significant improvement in the outcomes analyzed. Lasmiditan appears to be superior among the newer drugs in efficacy; however it has more adverse effects.
Role of Greater Occipital Nerve Block in Headache Disorders
Authors: Chowdhury Debashish , Datta Debabrata , Mundra Ankit 
Published: May 2021

Background:
The proximity of sensory neurons in the upper cervical spinal cord to the trigeminal nucleus caudalis (TNC) neurons and the convergence of sensory input to TNC neurons from both cervical and trigeminal fibers underscore the rationale of using greater occipital nerve block (GON-block) for acute and preventive treatment in various headache disorders.

Objective:
The aim of this study was to critically review the existing literature regarding the safety and efficacy of GON-block in various headache disorders.

Methods:
We searched the eligible studies in English by searching in PubMed till December 31, 2020 for randomized controlled trials (RCTs), observational studies, open-label studies, case series, and case reports on the efficacy and the safety of GON-block for the treatment of headache disorders using the keywords “greater occipital nerve block”, “headache” and “treatment”. Studies using combination of GON-block and other peripheral nerve blocks (PNBs) and C2/C3 blocks were excluded.

Results:
Seventy-two eligible studies were reviewed. Based on RCTs and open-label studies, good evidence of the efficacy of GON-block was found for migraine, cluster headache (CH), post-dural puncture headache (PDPH), cervicogenic headache (CGH), and occipital neuralgia (ON). The analgesic effect of GON-block outlasted its anesthetic effect by days to weeks. Evidence for acute and short-term (transitional) treatment was more robust than for long-term prevention. GON-block was found to be safe and the treatment-emergent adverse effects (TEAEs) were generally mild and transient.

Conclusion:
GON-block is a useful modality of treatment in various headache disorders because of many attractive features such as its early effect in reducing the severity of pain, sustained effect following a single injection, easy technique, minimum invasiveness, minimum TEAE, no drug-to-drug interactions, and negligible cost.
Borderlands of Migraine and Epilepsy
Authors: Garg Divyani , Tripathi Manjari 
Published: May 2021

Background:
The complex relationship between migraine and epilepsy has frequently been described to represent a clinical and electrographic “borderland.” These two conditions share clinical expressions such as paroxysmal and chronic nature, as well as semiology, particularly visual phenomenon.

Objective:
We aimed to review the current literature on the overlapping phenomena of migraine and epilepsy.

Materials and Methods:
We searched the PubMed for relevant literature and conducted a narrative review on migraine and epilepsy.

Results:
Migraine and epilepsy share a complex and pathophysiologically intriguing relationship. The International Classification of Headache Disorders, 3rd edition (ICHD-3) makes diagnostic provisions for migraine aura–triggered seizures (Subchapter 1.4.4) and headache attributed to epileptic seizure (Subchapter 7.6), the latter being further categorized as 7.6.1 Ictal epileptic headache, and 7.6.2 post-ictal headache. Neurological conditions such as certain channelopathies and epilepsy syndromes exhibit both conditions within their phenotypic spectrum, suggesting shared genetic and molecular underpinnings. Diagnostic confusion may arise, particularly between occipital epilepsy and the visual aura of migraine. Antiseizure medications may be effective for the treatment of migraines that occur in concert with epilepsy.

Conclusions:
Migraine and epilepsy share several clinical features and have intertwined genetic and molecular underpinnings, which may contribute to common pathogenesis. Electroencephalography may be useful as a diagnostic tool in selected cases.
Medical Management of Trigeminal Neuralgia
Authors: Khadilkar Satish V , Patil Varsha A 
Published: May 2021

Background:
Trigeminal neuralgia (TN) is a painful condition, often leading to poor quality of life.

Objective:
The aim of this review was to discuss the various treatment modalities for the medical management of TN.

Materials and Methods:
We reviewed the available literature on TN in clinical databases including PubMed, Google Scholar, and the Cochrane Database of Systematic Reviews, with a specific focus on the pharmacological treatment and newer drugs under development for the treatment of TN.

Results:
Carbamazepine (CBZ) is the gold standard of treatment for TN. The first-line drugs for the treatment of TN are CBZ and oxcarbazepine (OXC). A proportion of cases (30%) are initially resistant to the first-line drugs. Alternative drugs need to be considered if the first-line drugs are not well tolerated or become ineffective with prolonged therapy. The second-line drugs comprise lamotrigine, baclofen, gabapentin, and pregabalin used as monotherapy or in combination with CBZ/OXC. Botulinum toxin A may be a promising presurgical option. Newer drug like vixotrigine has shown good results in phase two randomized control trials. About 50% of cases develop treatment resistance to oral drugs over the subsequent years of therapy and require surgical options.

Conclusion:
The first-line drugs for the treatment of TN (irrespective of the age group or type) are CBZ and OXC. Combination therapy with second-line or other drugs may become necessary with poor response to CBZ/OXC, or if adverse events occur. Patients should be offered surgical options if there is poor response or tolerance to the medical therapy.
Role of Monoclonal Antibodies against Calcitonin Gene-Related Peptide (CGRP) in Episodic Migraine Prevention
Authors: Nagaraj Karthik , Vandenbussche Nicolas , Goadsby Peter J 
Published: May 2021

Background:
Medications targeting the calcitonin gene-related peptide (CGRP) pathway are exciting and novel therapeutic options in the treatment of migraine.

Objective:
In this article, we have reviewed the role of these CGRP monoclonal antibodies in patients with episodic migraine.

Materials and Methods:
We did an extensive literature search for all phase 2 and 3 studies involving CGRP monoclonal antibodies in episodic migraine.

Results:
Erenumab, fremanezumab, galcanezumab, and eptinezumab have all undergone phase 3 trials and have been found to be effective for episodic and chronic migraine. They have the advantage of being targeted therapies for migraine with very favorable adverse effect profiles comparable to placebo. Importantly, they are effective in subgroups of patients who have failed previous preventive therapies.

Conclusion:
Increasing use of these medications will certainly revolutionize the treatment and outlook for patients with migraine all over the world.
Noninvasive Neuromodulation in Headache
Authors: Lloyd Joseph , Biloshytska Maryna , Andreou Anna P , Lambru Giorgio 
Published: May 2021

Background:
Migraine is a common disabling primary headache condition. Although strives have been made in treatment, there remains an unmet need for safe, effective acute, and preventative treatments. The promising concept of neuromodulation of relevant neuronal targets in a noninvasive fashion for the treatment of primary headache disorders has led to the trial of numerous devices over the years.

Objective:
We aimed to review the evidence on current neuromodulation treatments available for the management of primary headache disorders.

Methods:
Randomized controlled trial as well as open-label and real-world studies on central and peripheral cephalic and noncephalic neuromodulation modalities in primary headaches were critically reviewed.

Results:
The current evidence suggests a role of single-pulse transcranial magnetic stimulation, supraorbital nerve stimulation, and remote noncephalic electrical stimulation as migraine abortive treatments, with stronger evidence in episodic rather than in chronic migraine. Single-pulse transcranial magnetic stimulation and supraorbital nerve stimulation also hold promising evidence in episodic migraine prevention and initial positive evidence in chronic migraine prevention. More evidence should clarify the therapeutic role of the external vagus nerve stimulation and transcranial direct current stimulation in migraine. However, external vagus nerve stimulation may be effective in the acute treatment of episodic but not chronic cluster headache, in the prevention of hemicrania continua and paroxysmal hemicrania but not of short-lasting neuralgiform headache attacks. The difficulty in setting up sham-controlled studies has thus far prevented the publication of robust trials. This limitation along with the cost of these therapies has meant that their use is limited in most countries.

Conclusion:
Neuromodulation is a promising nonpharmacological treatment approach for primary headaches. More studies with appropriate blinding strategies and reduction of device cost may allow more widespread approval of these treatments and in turn increase clinician's experience in neuromodulation.
Surgical Options for Migraine
Authors: Totonchi Ali , Guyuron Bahman , Ansari Hossein 
Published: May 2021

Objective:
The goal of this manuscript was to provide a comprehensive review of the surgical treatment for migraine headaches with a focus on trigger points and their clinical presentations, and to emphasize the importance of appropriate patient selection.

Background:
Migraine is a prevalent neurological disease with headache being a disabling component of it. Surgical treatment for migraine headache became available two decades ago, which is based on proper identification and the deactivation of the specific trigger sites in the head and neck area.

Design:
This manuscript reviews the discovery and evolution of migraine surgery with changes in patients' selection throughout the years.

Conclusion:
Patients with migraine headaches who do not respond or cannot tolerate the medical treatment might benefit from trigger site deactivation surgery. The success of the surgery is closely related to proper identification of trigger point (s) and close collaboration with a neurologist or a headache specialist. This collaboration would enhance patients' positive outcomes and help to rule out other causes of the headache.
The Relationship between Health Literacy Dimensions and Perceived Risk of Cardiovascular Disease in Middle-Aged Iranian Women
Authors: Enjezab Behnaz , Zarehosseinabadi Fatemeh , Tafti Arefeh Dehghani , Zarehosseinabadi Mina 
Published: May 2021

Background:
The purpose of the study was to investigate the relationship between health literacy dimensions and the perceived risk of cardiovascular disease in middle-aged Iranian women.

Materials and Methods:
This is a descriptive-correlational study in which 280 women aged 40–60 years were investigated by random cluster sampling out of seven health centers in Yazd city in 2018. Data collection tools included predesigned demographic information from a standard Health Literacy for Iranian Adults (HELIA), and a standard perceived susceptibility and perceived risk components of the preventive behaviors of cardiovascular disease questionnaire. The data were analyzed using one-way ANOVA, independent t-test, Kruskal-Wallis, and Mann Whitney tests.

Results:
A significant relationship was identified between demographic information and health literacy (p < 0.001). The mean (SD) scores of the perceived risk of cardiovascular disease and health literacy appeared to be 30.71 (5.10) and 35.62 (15.32), respectively. The perceived risk of cardiovascular disease in the participants turned out to be significantly correlated with the accessibility dimension of health literacy (r = 0.31, p < 0.001), but it failed to have any significant relationship with demographic information, especially obesity.

Conclusions:
As there is a significant relationship between health literacy and perceived risk of cardiovascular disease, hence increasing the health literacy of middle-aged women, especially in persons with high body mass index through the media and health centers, considered as an important source of health information, can be an appropriate task to augment the perceived risk of cardiovascular diseases.
Experience of Workplace Incivility and Its Impact on Stress and Turnover Intention among the Nurses Working at a Hospital
Authors: Kanitha Devan , Naik Poonam R. 
Published: May 2021

Background:
Incivility in the workplace drowns the mental health of the nurses and hampers the daily routine. The majority of the nurses working at hospitals were experiencing incivility. It affects the physical and psychological health of the nurses. Experience of workplace incivility and its impact on stress and turnover among nurses was discussed in this study.

Materials and Methods:
Cross-sectional survey approach was used to select 50 nurses by simple random sampling technique. Standard scales for incivility, stress, and pre-tested scale for the turnover intention was used to collect the data.

Result:
Nurses experience incivility in their workplace almost from all the sources. The majority (64%) of the staff nurses had a moderate level of stress and 30% had average intention to leave the present job. There was a positive relationship found between the experience of incivility and stress (r = 0.43, p < 0.002), stress, and turnover intention (r = 0.40, p < 0.004).

Conclusions:
Experience of incivility provokes stress among the nurses, and this may influence turnover intention.
Iranian Women's Self-concept after Hysterectomy
Authors: Goudarzi Fatemeh , Khadivzadeh Talat , Ebadi Abbas , Babazadeh Raheleh 
Published: May 2021

Background:
The loss of female organs leads to profound changes in one's perception of oneself. There is limited information about the impact of hysterectomy on women's self-concept and culture. Therefore, this study was conducted with the aim to deepen our understanding of the self-concept of Iranian women after hysterectomy.

Materials and Methods:
This qualitative study was conducted using directed content analysis approach. The participants included 30 women with a history of hysterectomy who were selected through purposive sampling method. Data were collected from August 2018 to November 2019 using in-depth and semi-structured interviews based on the self-concept mode of the Roy Adaptation Model (RAM) in Mashhad, Iran. Data analysis was performed using the deductive approach of Elo and Kyngäs in MAXQDA software.

Results:
As a result of the analysis of the interviews, the main category of “incoherent cognition of self-concept” emerged, which included the two generic categories of “heterogeneous feelings toward and imaginations of the body” and “changed self-perception”, and five subcategories.

Conclusions:
Women's self-concept changed after hysterectomy in both its physical and psychological aspects. Therefore, counseling before and after hysterectomy is recommended to improve women's self-concept after hysterectomy.
Pediatric Ward Nurses’ Caring Self-Efficacy Scale
Authors: Bahrami Masoud , Alavi Azam , Zargham-Boroujeni Ali , Yousefy Alireza 
Published: May 2021

Background:
No instrument specifically designed to investigate the caring self-efficacy of nurses in pediatric wards was found. The aim of the present study was therefore to develop a scale to evaluate pediatric wards nurse's caring self-efficacy.

Materials and Methods:
In this study, an exploratory, sequential, mixed method was used in 2015 in Iran. Data collected from 27 semi-structured interviews with nurses in pediatric wards were analyzed using conventional content analysis. The initial version of the scale was obtained with 65 items. Face validity was determined using impact score and content validity using the Content Validity Index (CVI) and Content Validity Ratio (CVR). The construct validity of the scale was investigated using exploratory factor analysis with 305 nurses in pediatric wards. The concurrent validity of the scale was acquired using the General Self-Efficacy Scale. Internal consistency and test–retest reliability were also examined.

Results:
The scale-CVI (S-CVI) (average) was 0.85. The 14 items with a CVR and CVI of less than 0.51 and 0.70, respectively, were deleted and the final 51-item scale was approved. All 51 items had good impact score (>1.50). In the final scale, four subscales were extracted using construct validity. The concurrent validity of the scale was also obtained (r = 0.77, p < 0.001). The total Cronbach's α correlation coefficient of the scale was 0.96 and test–retest reliability was 0.98.

Conclusions:
The Pediatric Ward Nurses' Caring Self-Efficacy (PWNCSE) scale developed in this study is a practical, reliable, and valid scale to evaluate pediatric ward nurses' caring self-efficacy.