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Papers by Marcin Straburzyński

The Journal of Headache and Pain

Background The Migraine in Poland study is the first large scale nationwide cross-sectional onlin... more Background The Migraine in Poland study is the first large scale nationwide cross-sectional online survey of symptoms, approaches to management, treatment patterns, quality of life, and sociodemographic characteristics of the Polish migraine patients’ cohort, conducted from August 2021 to June 2022. Methods A cross-sectional online survey was designed based on the American Migraine Prevalence and Prevention (AMPP) Study. Participants were recruited through broad advertisement through various channels. The survey included questions allowing for the diagnosis of migraine without aura (MwoA) based on the third edition of the International Classification of Headache Disorders (ICHD-3). Moreover, the questionnaire assessed sociodemographic and headache features, comorbidities, consultation rates with medical professionals, as well as the use of abortive or preventive treatment, including non-pharmacological methods, psychological symptoms and the burden of migraine. Results A structured ...

Otolaryngologia Polska

Background: Acute rhinosinusitis (ARS) is a common and well-defined disorder, primarily of viral ... more Background: Acute rhinosinusitis (ARS) is a common and well-defined disorder, primarily of viral aetiology, with rhinovirus and coronavirus accounting for more than 50% of viral ARS. The fight with COVID-19 pandemic resulted in an increased availability viral testing, which in turn allowed testing for presence of SARS-Cov-2 in all patients presenting common cold (or ARS) symptoms. The aim of this study was to assess the clinical characteristics of acute rhinosinusitis in patients diagnosed with COVID-19.Methodology/Principal: This study is a post-hoc analysis. Patients symptoms were evaluated using a structured questionnaire twice: directly after a positive SARS-Cov-2 result and 7-12 days following the first evaluation. Subjects were asked about presence of nasal and systemic symptoms as well as headache.Results: A total of 130 COVID-19 symptomatic patients were recruited into the study, 58 (45%) patients met EPOS2020 diagnostic criteria for ARS. Of all ARS patients, 72% presented w...

International Journal of Environmental Research and Public Health

The identification of patients who can benefit the most from the available preventive treatments ... more The identification of patients who can benefit the most from the available preventive treatments is important in chronic migraine. We explored the rate of excellent responders to onabotulinumtoxinA in a multicenter European study and explored the predictors of such response, according to different definitions. A pooled analysis on chronic migraineurs treated with onabotulinumtoxinA and followed-up for, at least, 9 months was performed. Excellent responders were defined either as patients with a ≥75% decrease in monthly headache days (percent-based excellent responders) or as patients with <4 monthly headache days (frequency-based excellent responders). The characteristics of excellent responders at the baseline were compared with the ones of patients with a <30% decrease in monthly headache days. Percent-based excellent responders represented about 10% of the sample, whilst frequency-based excellent responders were about 5% of the sample. Compared with non-responders, percent-...

Neurologia i Neurochirurgia Polska

Headache is one of the most prevalent, although often underreported, symptoms of coronavirus dise... more Headache is one of the most prevalent, although often underreported, symptoms of coronavirus disease 2019 (COVID-19). It is generally accepted that this symptom is a form of secondary headache due to systemic viral infection. There are several hypotheses that try to explain its aetiopathogenesis. One of the most compelling is related to innate immune response to viral infection. This rationale is supported by similarities to other viral infections and the temporal overlap between immunological reactions and headache. Moreover, several key factors in innate immunity have been shown to facilitate headache e.g. interferons, interleukin (IL)-1-β, IL-6, and tumour necrosis factor. There is also a possibility that the virus causes headache by the direct activation of afferents through pattern recognition receptors (i.e. Toll-like receptor 7). Moreover, some data on post-COVID-19 headache and after vaccination against SARS-CoV-2 infection suggests a similar cytokine-mediated pathomechanism in these clinical situations. Future research should look for evidence of causality between particular immune response factors and headache. Identifying key molecules responsible for headache during acute viral infection would be an important step towards managing one of the most prevalent secondary headache disorders.

Polski Przegląd Neurologiczny, Apr 24, 2022

Frontiers in Neurology

IntroductionMonoclonal antibodies (mAbs) showed efficacy in migraine prevention. The aim of this ... more IntroductionMonoclonal antibodies (mAbs) showed efficacy in migraine prevention. The aim of this study was to check if baseline clinical parameters and cerebral blood flow (CBF) measured by transcranial Doppler (TCD) may help predict mAbs efficacy.MethodsElectronic charts of migraineurs treated with erenumab or fremanezumab, with baseline TCD evaluations were collected, including data on migraine type, pain localization, monthly migraine days (MMD), medication overuse headache (MOH), mean blood flow velocity (Vm), and pulsatility index (PI) in cerebral arteries.ResultsA total of 123 patients were enrolled, mean age 38, 75 years, 87 with chronic migraine, 61 with MOH, 72 were good responders (GR), and reported ≥50% reduction in MMD, 43 ≥75% reduction in MMD. Baseline Vm values in MCAs were significantly lower in GR as compared with non-responders. MAbs responsiveness ≥50% was positively associated with unilateral pain localization (OR: 6.53, 95% CI: 2.01–23.93; p = 0.003) and HIT-6 s...

Journal of Headache and Pain, Mar 31, 2022

Background: Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are use... more Background: Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are used to reduce the risk of developing Coronavirus Disease 2019 (COVID-19). Despite the significant benefits in terms of reduced risk of hospitalization and death, different adverse events may present after vaccination: among them, headache is one of the most common, but nowadays there is no summary presentation of its incidence and no description of its main features. Methods: We searched PubMed and EMBASE covering the period between January 1 st 2020 and August 6 th , 2021, looking for record in English and with an abstract and using three main search terms (with specific variations): COVID-19/SARS-CoV-2; Vaccination; headache/adverse events. We selected manuscript including information on subjects developing headache after injection, and such information had to be derived from a structured form (i.e. no free reporting). Pooled estimates and 95% confidence intervals were calculated. Analyses were carried out by vaccine vs. placebo, by first vs. second dose, and by mRNA-based vs. "traditional" vaccines; finally, we addressed the impact of age and gender on post-vaccine headache onset.

Journal of Clinical Medicine, 2021

Erenumab showed efficacy in migraine prevention, however we cannot identify which patients to tre... more Erenumab showed efficacy in migraine prevention, however we cannot identify which patients to treat by predicting efficacy response. The aim of this study was to compare changes in cerebral blood flow (CBF) reflected by transcranial Doppler (TCD) in erenumab good responders (GR) and non-responders, in order to identify a parameter that could predict the treatment response. In this study, migraineurs treated with erenumab underwent clinical and TCD evaluations before and 6 weeks after the treatment, including data on migraine type, monthly migraine days (MMD), medication overuse headache (MOH) presence, mean blood flow velocity (Vm) and pulsatility index (PI) in cerebral arteries (CA). GR were defined as reporting ≥50% reduction in MMD. Thirty women were enrolled, of mean age 40.53 years, 20 with chronic migraine, 14 with MOH, and 19 were GR. Baseline Vm values in right CA and basilar artery (BA) were significantly lower in GR as compared with non-responders. Vm values in all arterie...

Migrena jest uwar unkowanym genetycznie pier wotnym bolem glowy, ktory przebiega z epizodycznymi ... more Migrena jest uwar unkowanym genetycznie pier wotnym bolem glowy, ktory przebiega z epizodycznymi napadami, miedzy ktorymi u chorych wystepuje stala gotowośc do ich rozwiniecia. Wieloczynnikowa i zlozona etiopatogeneza tej choroby znacznie utrudnia skuteczne leczenie. Autorzy na podstawie najnowszych doniesien i pr zeglądu badan klinicznych pr zedstawili aktualny stan wiedzy dotyczący leczenia doraźnego i profilaktycznego migreny. W ar tykule omowiono takze pr zyszle terapie, z ktor ymi są wiązane duze nadzieje i ktore byc moze w niedalekiej przyszlości poszerzą mozliwości skutecznego leczenia migreny.

In the intervening years 1928 and 1931 Curt Rosenthal and Ernt Melkersson described a lot of pati... more In the intervening years 1928 and 1931 Curt Rosenthal and Ernt Melkersson described a lot of patients with triad of symptoms: recurring facial paralysis, swelling of the face and lips and scrotal tongue. Currently this relatively rare triad of symptoms has termed Melkersson-Rosenthal syndrome (MRS). In 1945 Miescher described a few cases of primary interstitial inflammation of the lips and gave them the name granulomatous macrocheilitis (GM). A lot of his patients additionally had facial nerve paralysis, and/or swelling of the face and issured tongue. At present it is very difficult to differentiate the Melkersson-Rosenthal Syndrome and granulomatous macrocheilitis. In the case report we present the study of persistent lower lip swelling with its diagnostics and we propose a therapeutic method – trimacynolone injection together with metronidazole.

Pain and Therapy, 2021

Introduction: Migraine is mostly a female disorder because of its lower prevalence in men. Less t... more Introduction: Migraine is mostly a female disorder because of its lower prevalence in men. Less than 20% of patients included in the available studies on migraine treatments are men; hence, the evidence on migraine treatments might not apply to men. The aims of the present study were to provide reliable information on the effectiveness of onabotulinumtox-inA (BT-A) for chronic migraine in men and to

Pain and Therapy, 2021

Introduction: OnabotulinumtoxinA (BT-A) quarterly was the first treatment approved specifically f... more Introduction: OnabotulinumtoxinA (BT-A) quarterly was the first treatment approved specifically for chronic migraine (CM). It is unclear whether three cycles are better than two to assess early BT-A response. Methods: We performed a retrospective analysis on real-life prospectively collected data in 16 European headache centers. All the centers provided data on patients treated with BT-A for CM over the first three cycles of treatment. For each treatment cycle we defined patients as ''good responders'' if reporting a C 50% reduction in monthly headache days compared with the three months before starting BT-A, ''partial responders'' if reporting a 30-49% reduction in monthly headache days, and ''non-responders'' if reporting a \ 30% reduction in monthly

Cephalalgia, 2021

Background The genesis of headache in coronavirus disease 2019 (COVID-19) is currently unclear an... more Background The genesis of headache in coronavirus disease 2019 (COVID-19) is currently unclear and the multitude of disease symptoms often further hinders locating the source of pain. Interestingly, many subjects with COVID-19 have symptoms of acute rhinosinusitis. The relation between nasal symptoms and headache in SARS-CoV-2 infection remains unknown. Methods This bi-center longitudinal study evaluated symptoms in consecutive COVID-19 patients in the participating practices. The first assessment was performed during the initial consultation after infection confirmation. That was followed up by a second consultation after a median 9 days. Results 130 patients were included in the study (80 women, 50 men; mean age 46.9 years). Headache was highly prevalent at the first visit (72%) and significantly associated with acute rhinosinusitis symptoms. The odds ratio for headache in subjects with rhinosinusitis was 3.5. Headache could be attributed to systemic viral infection in 96% and to ...

European Archives of Oto-Rhino-Laryngology, 2021

I have read with great interest the meta-analysis “Endoscopic surgical treatment for rhinogenic c... more I have read with great interest the meta-analysis “Endoscopic surgical treatment for rhinogenic contact point headache: systematic review and meta-analysis” published in a recent issue of the European Archives of Oto-Rhino-Laryngology. The authors chose to analyse the truly important and controversial subject of headache and facial pain attributed to contact point within the nasal cavity. However, several points in this analysis call for a comment from the headache specialist perspective. First, it should be stressed that headache attributed to mucosal contact point (MCP) is not as yet recognised by the International Classification of Headache Disorders. The current 3rd version mentions headache attributed to disorder of the nasal mucosa, turbinates or septum. However, this type of headache is included only in the appendix with too little evidence for its existence [1]. There are no studies which have shown that occurrence of MCP increases the risk of headache. Moreover, a considerable group of rhinologists doubt its existence [2]. But there is another side to MCP headache: many surgeons indicate excellent results of interventions targeted at MCP removal. The number of studies describing surgery targeted at MCP far exceeds endoscopic trials included by Maniaci et al. Unfortunately, meta-analysis of evidence in this field is challenging, since the majority of studies are of low value according to evidence-grading systems. However, there exist several prospective controlled randomized trials (level 2B according to Centre for Evidence-Based Medicine). In this context, selection criteria of this metaanalysis seem to be too inclusive—authors chose to mix the results from higher grade studies with uncontrolled case series (level 4). This approach allows for higher participants numbers, but must consequently lead to depreciation of this meta-analysis’ scientific value. There are also other issues regarding study selection in this meta-analysis. According to Maniaci et al., ‘the studies included only clinically confirmed cases of rhinogenic point of contact headache’. Yet that seems to be inaccurate, as the authors of four included trials state that they recruited subjects with primary headaches (mostly refractory migraine) [3–5]. These authors do not confirm a clinical diagnosis of MCP headache. Some of them explicitly state that they believe MCP was the trigger and/or cause for refractoriness of migraine and not a separate rhinogenic headache [3, 4]. Also difficult to justify is the inclusion in this meta-analysis of the study by Guyuron et al. [6]. Not only this study specifically targeted subjects with migraine, but also nasal surgery was just one of many surgical interventions performed. The number of subjects that had nasal surgery in that study was lower than the number included in the meta-analysis. In conclusion, there are strong indications that MCP surgery may become a viable option in headache medicine in the future. Yet the selection process in this meta-analysis prevents conclusions regarding whether MCP surgery should be used in MCP (rhinogenic) headache, migraine or both. Moreover, as there are no sham surgery controlled trials included, we must further await a definite confirmation of MCP surgery effectiveness. The results might yet be surprising, if we draw an analogy to balloon sinuplasty, where surgery was no better than a sham in reducing sinus headache/ pressure [7].

Brain Sciences, 2021

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Brain Sciences, 2020

Both tinnitus and headache are very prevalent conditions in the general population, with bidirect... more Both tinnitus and headache are very prevalent conditions in the general population, with bidirectional co-occurrence of them. A number of studies revealed a high prevalence of headache in tinnitus patients; however, most of them used self-reported symptoms, questionnaires, or health databases and were retrospective. The aim of this study was to evaluate the prevalence of different types of headache in a cohort of tinnitus patients and to assess the influence of headache on tinnitus parameters, focusing on appropriate headache and tinnitus diagnosis verified by clinical examination. This prospective study involved 286 patients diagnosed with subjective non-pulsating tinnitus. Patients’ clinical information was thoroughly assessed by the multidisciplinary team, including tinnitus characteristics and severity according to the Tinnitus Handicap Inventory (THI), loudness assessed by the Visual Analogue Scale (VAS), audiometry, type of headache diagnosed according to the third edition of ...

The Journal of Headache and Pain

Background The Migraine in Poland study is the first large scale nationwide cross-sectional onlin... more Background The Migraine in Poland study is the first large scale nationwide cross-sectional online survey of symptoms, approaches to management, treatment patterns, quality of life, and sociodemographic characteristics of the Polish migraine patients’ cohort, conducted from August 2021 to June 2022. Methods A cross-sectional online survey was designed based on the American Migraine Prevalence and Prevention (AMPP) Study. Participants were recruited through broad advertisement through various channels. The survey included questions allowing for the diagnosis of migraine without aura (MwoA) based on the third edition of the International Classification of Headache Disorders (ICHD-3). Moreover, the questionnaire assessed sociodemographic and headache features, comorbidities, consultation rates with medical professionals, as well as the use of abortive or preventive treatment, including non-pharmacological methods, psychological symptoms and the burden of migraine. Results A structured ...

Otolaryngologia Polska

Background: Acute rhinosinusitis (ARS) is a common and well-defined disorder, primarily of viral ... more Background: Acute rhinosinusitis (ARS) is a common and well-defined disorder, primarily of viral aetiology, with rhinovirus and coronavirus accounting for more than 50% of viral ARS. The fight with COVID-19 pandemic resulted in an increased availability viral testing, which in turn allowed testing for presence of SARS-Cov-2 in all patients presenting common cold (or ARS) symptoms. The aim of this study was to assess the clinical characteristics of acute rhinosinusitis in patients diagnosed with COVID-19.Methodology/Principal: This study is a post-hoc analysis. Patients symptoms were evaluated using a structured questionnaire twice: directly after a positive SARS-Cov-2 result and 7-12 days following the first evaluation. Subjects were asked about presence of nasal and systemic symptoms as well as headache.Results: A total of 130 COVID-19 symptomatic patients were recruited into the study, 58 (45%) patients met EPOS2020 diagnostic criteria for ARS. Of all ARS patients, 72% presented w...

International Journal of Environmental Research and Public Health

The identification of patients who can benefit the most from the available preventive treatments ... more The identification of patients who can benefit the most from the available preventive treatments is important in chronic migraine. We explored the rate of excellent responders to onabotulinumtoxinA in a multicenter European study and explored the predictors of such response, according to different definitions. A pooled analysis on chronic migraineurs treated with onabotulinumtoxinA and followed-up for, at least, 9 months was performed. Excellent responders were defined either as patients with a ≥75% decrease in monthly headache days (percent-based excellent responders) or as patients with <4 monthly headache days (frequency-based excellent responders). The characteristics of excellent responders at the baseline were compared with the ones of patients with a <30% decrease in monthly headache days. Percent-based excellent responders represented about 10% of the sample, whilst frequency-based excellent responders were about 5% of the sample. Compared with non-responders, percent-...

Neurologia i Neurochirurgia Polska

Headache is one of the most prevalent, although often underreported, symptoms of coronavirus dise... more Headache is one of the most prevalent, although often underreported, symptoms of coronavirus disease 2019 (COVID-19). It is generally accepted that this symptom is a form of secondary headache due to systemic viral infection. There are several hypotheses that try to explain its aetiopathogenesis. One of the most compelling is related to innate immune response to viral infection. This rationale is supported by similarities to other viral infections and the temporal overlap between immunological reactions and headache. Moreover, several key factors in innate immunity have been shown to facilitate headache e.g. interferons, interleukin (IL)-1-β, IL-6, and tumour necrosis factor. There is also a possibility that the virus causes headache by the direct activation of afferents through pattern recognition receptors (i.e. Toll-like receptor 7). Moreover, some data on post-COVID-19 headache and after vaccination against SARS-CoV-2 infection suggests a similar cytokine-mediated pathomechanism in these clinical situations. Future research should look for evidence of causality between particular immune response factors and headache. Identifying key molecules responsible for headache during acute viral infection would be an important step towards managing one of the most prevalent secondary headache disorders.

Polski Przegląd Neurologiczny, Apr 24, 2022

Frontiers in Neurology

IntroductionMonoclonal antibodies (mAbs) showed efficacy in migraine prevention. The aim of this ... more IntroductionMonoclonal antibodies (mAbs) showed efficacy in migraine prevention. The aim of this study was to check if baseline clinical parameters and cerebral blood flow (CBF) measured by transcranial Doppler (TCD) may help predict mAbs efficacy.MethodsElectronic charts of migraineurs treated with erenumab or fremanezumab, with baseline TCD evaluations were collected, including data on migraine type, pain localization, monthly migraine days (MMD), medication overuse headache (MOH), mean blood flow velocity (Vm), and pulsatility index (PI) in cerebral arteries.ResultsA total of 123 patients were enrolled, mean age 38, 75 years, 87 with chronic migraine, 61 with MOH, 72 were good responders (GR), and reported ≥50% reduction in MMD, 43 ≥75% reduction in MMD. Baseline Vm values in MCAs were significantly lower in GR as compared with non-responders. MAbs responsiveness ≥50% was positively associated with unilateral pain localization (OR: 6.53, 95% CI: 2.01–23.93; p = 0.003) and HIT-6 s...

Journal of Headache and Pain, Mar 31, 2022

Background: Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are use... more Background: Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are used to reduce the risk of developing Coronavirus Disease 2019 (COVID-19). Despite the significant benefits in terms of reduced risk of hospitalization and death, different adverse events may present after vaccination: among them, headache is one of the most common, but nowadays there is no summary presentation of its incidence and no description of its main features. Methods: We searched PubMed and EMBASE covering the period between January 1 st 2020 and August 6 th , 2021, looking for record in English and with an abstract and using three main search terms (with specific variations): COVID-19/SARS-CoV-2; Vaccination; headache/adverse events. We selected manuscript including information on subjects developing headache after injection, and such information had to be derived from a structured form (i.e. no free reporting). Pooled estimates and 95% confidence intervals were calculated. Analyses were carried out by vaccine vs. placebo, by first vs. second dose, and by mRNA-based vs. "traditional" vaccines; finally, we addressed the impact of age and gender on post-vaccine headache onset.

Journal of Clinical Medicine, 2021

Erenumab showed efficacy in migraine prevention, however we cannot identify which patients to tre... more Erenumab showed efficacy in migraine prevention, however we cannot identify which patients to treat by predicting efficacy response. The aim of this study was to compare changes in cerebral blood flow (CBF) reflected by transcranial Doppler (TCD) in erenumab good responders (GR) and non-responders, in order to identify a parameter that could predict the treatment response. In this study, migraineurs treated with erenumab underwent clinical and TCD evaluations before and 6 weeks after the treatment, including data on migraine type, monthly migraine days (MMD), medication overuse headache (MOH) presence, mean blood flow velocity (Vm) and pulsatility index (PI) in cerebral arteries (CA). GR were defined as reporting ≥50% reduction in MMD. Thirty women were enrolled, of mean age 40.53 years, 20 with chronic migraine, 14 with MOH, and 19 were GR. Baseline Vm values in right CA and basilar artery (BA) were significantly lower in GR as compared with non-responders. Vm values in all arterie...

Migrena jest uwar unkowanym genetycznie pier wotnym bolem glowy, ktory przebiega z epizodycznymi ... more Migrena jest uwar unkowanym genetycznie pier wotnym bolem glowy, ktory przebiega z epizodycznymi napadami, miedzy ktorymi u chorych wystepuje stala gotowośc do ich rozwiniecia. Wieloczynnikowa i zlozona etiopatogeneza tej choroby znacznie utrudnia skuteczne leczenie. Autorzy na podstawie najnowszych doniesien i pr zeglądu badan klinicznych pr zedstawili aktualny stan wiedzy dotyczący leczenia doraźnego i profilaktycznego migreny. W ar tykule omowiono takze pr zyszle terapie, z ktor ymi są wiązane duze nadzieje i ktore byc moze w niedalekiej przyszlości poszerzą mozliwości skutecznego leczenia migreny.

In the intervening years 1928 and 1931 Curt Rosenthal and Ernt Melkersson described a lot of pati... more In the intervening years 1928 and 1931 Curt Rosenthal and Ernt Melkersson described a lot of patients with triad of symptoms: recurring facial paralysis, swelling of the face and lips and scrotal tongue. Currently this relatively rare triad of symptoms has termed Melkersson-Rosenthal syndrome (MRS). In 1945 Miescher described a few cases of primary interstitial inflammation of the lips and gave them the name granulomatous macrocheilitis (GM). A lot of his patients additionally had facial nerve paralysis, and/or swelling of the face and issured tongue. At present it is very difficult to differentiate the Melkersson-Rosenthal Syndrome and granulomatous macrocheilitis. In the case report we present the study of persistent lower lip swelling with its diagnostics and we propose a therapeutic method – trimacynolone injection together with metronidazole.

Pain and Therapy, 2021

Introduction: Migraine is mostly a female disorder because of its lower prevalence in men. Less t... more Introduction: Migraine is mostly a female disorder because of its lower prevalence in men. Less than 20% of patients included in the available studies on migraine treatments are men; hence, the evidence on migraine treatments might not apply to men. The aims of the present study were to provide reliable information on the effectiveness of onabotulinumtox-inA (BT-A) for chronic migraine in men and to

Pain and Therapy, 2021

Introduction: OnabotulinumtoxinA (BT-A) quarterly was the first treatment approved specifically f... more Introduction: OnabotulinumtoxinA (BT-A) quarterly was the first treatment approved specifically for chronic migraine (CM). It is unclear whether three cycles are better than two to assess early BT-A response. Methods: We performed a retrospective analysis on real-life prospectively collected data in 16 European headache centers. All the centers provided data on patients treated with BT-A for CM over the first three cycles of treatment. For each treatment cycle we defined patients as ''good responders'' if reporting a C 50% reduction in monthly headache days compared with the three months before starting BT-A, ''partial responders'' if reporting a 30-49% reduction in monthly headache days, and ''non-responders'' if reporting a \ 30% reduction in monthly

Cephalalgia, 2021

Background The genesis of headache in coronavirus disease 2019 (COVID-19) is currently unclear an... more Background The genesis of headache in coronavirus disease 2019 (COVID-19) is currently unclear and the multitude of disease symptoms often further hinders locating the source of pain. Interestingly, many subjects with COVID-19 have symptoms of acute rhinosinusitis. The relation between nasal symptoms and headache in SARS-CoV-2 infection remains unknown. Methods This bi-center longitudinal study evaluated symptoms in consecutive COVID-19 patients in the participating practices. The first assessment was performed during the initial consultation after infection confirmation. That was followed up by a second consultation after a median 9 days. Results 130 patients were included in the study (80 women, 50 men; mean age 46.9 years). Headache was highly prevalent at the first visit (72%) and significantly associated with acute rhinosinusitis symptoms. The odds ratio for headache in subjects with rhinosinusitis was 3.5. Headache could be attributed to systemic viral infection in 96% and to ...

European Archives of Oto-Rhino-Laryngology, 2021

I have read with great interest the meta-analysis “Endoscopic surgical treatment for rhinogenic c... more I have read with great interest the meta-analysis “Endoscopic surgical treatment for rhinogenic contact point headache: systematic review and meta-analysis” published in a recent issue of the European Archives of Oto-Rhino-Laryngology. The authors chose to analyse the truly important and controversial subject of headache and facial pain attributed to contact point within the nasal cavity. However, several points in this analysis call for a comment from the headache specialist perspective. First, it should be stressed that headache attributed to mucosal contact point (MCP) is not as yet recognised by the International Classification of Headache Disorders. The current 3rd version mentions headache attributed to disorder of the nasal mucosa, turbinates or septum. However, this type of headache is included only in the appendix with too little evidence for its existence [1]. There are no studies which have shown that occurrence of MCP increases the risk of headache. Moreover, a considerable group of rhinologists doubt its existence [2]. But there is another side to MCP headache: many surgeons indicate excellent results of interventions targeted at MCP removal. The number of studies describing surgery targeted at MCP far exceeds endoscopic trials included by Maniaci et al. Unfortunately, meta-analysis of evidence in this field is challenging, since the majority of studies are of low value according to evidence-grading systems. However, there exist several prospective controlled randomized trials (level 2B according to Centre for Evidence-Based Medicine). In this context, selection criteria of this metaanalysis seem to be too inclusive—authors chose to mix the results from higher grade studies with uncontrolled case series (level 4). This approach allows for higher participants numbers, but must consequently lead to depreciation of this meta-analysis’ scientific value. There are also other issues regarding study selection in this meta-analysis. According to Maniaci et al., ‘the studies included only clinically confirmed cases of rhinogenic point of contact headache’. Yet that seems to be inaccurate, as the authors of four included trials state that they recruited subjects with primary headaches (mostly refractory migraine) [3–5]. These authors do not confirm a clinical diagnosis of MCP headache. Some of them explicitly state that they believe MCP was the trigger and/or cause for refractoriness of migraine and not a separate rhinogenic headache [3, 4]. Also difficult to justify is the inclusion in this meta-analysis of the study by Guyuron et al. [6]. Not only this study specifically targeted subjects with migraine, but also nasal surgery was just one of many surgical interventions performed. The number of subjects that had nasal surgery in that study was lower than the number included in the meta-analysis. In conclusion, there are strong indications that MCP surgery may become a viable option in headache medicine in the future. Yet the selection process in this meta-analysis prevents conclusions regarding whether MCP surgery should be used in MCP (rhinogenic) headache, migraine or both. Moreover, as there are no sham surgery controlled trials included, we must further await a definite confirmation of MCP surgery effectiveness. The results might yet be surprising, if we draw an analogy to balloon sinuplasty, where surgery was no better than a sham in reducing sinus headache/ pressure [7].

Brain Sciences, 2021

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Brain Sciences, 2020

Both tinnitus and headache are very prevalent conditions in the general population, with bidirect... more Both tinnitus and headache are very prevalent conditions in the general population, with bidirectional co-occurrence of them. A number of studies revealed a high prevalence of headache in tinnitus patients; however, most of them used self-reported symptoms, questionnaires, or health databases and were retrospective. The aim of this study was to evaluate the prevalence of different types of headache in a cohort of tinnitus patients and to assess the influence of headache on tinnitus parameters, focusing on appropriate headache and tinnitus diagnosis verified by clinical examination. This prospective study involved 286 patients diagnosed with subjective non-pulsating tinnitus. Patients’ clinical information was thoroughly assessed by the multidisciplinary team, including tinnitus characteristics and severity according to the Tinnitus Handicap Inventory (THI), loudness assessed by the Visual Analogue Scale (VAS), audiometry, type of headache diagnosed according to the third edition of ...