Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Randomized Controlled Trial
Dramatic placebo effect of high frequency repetitive TMS in treatment of chronic migraine and medication overuse headache.
Chronic migraine (CM) is often associated with medication overuse headache (MOH). Few small trials have been conducted on Transcranial Magnetic Stimulation for CM treatment, but results are conflicting. Aim of the study was to investigate the effects of high frequency of repetitive Transcranial Magnetic Stimulation (hf-rTMS) in the dorsolateral prefrontal cortex combined with strongly suggesting to avoid medications overuse in patients suffering with CM and MOH. ⋯ There were no significant differences between groups at T0 in demographic data and headache measures. Mean number of HD, HH, SDI, and MIDAS similarly reduced in the two groups. Our study failed in demonstrating that hf-rTMS with detoxification advice could be better than detoxification advice alone in CM treatment. hf-rTMS carries a high potential of inducing placebo effect and this can be usefully leveraged to enhance patients' coping strategies.
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Increased lactate in cerebrospinal fluid (CSF) has been regarded as a marker for cerebral ischemia and damage in the central nervous system. The aim of this study was to evaluate if CSF-lactate was associated with; impaired cerebral circulation, outcome, sex, age, clinical condition or treatment after subarachnoid haemorrhage (SAH). ⋯ In patients with SAH, no association was found between increased CSF-lactate (>2.1 mmol/L) and severe clinical condition, impaired cerebral circulation or unfavourable outcome. Endovascular coiling and age ≥61 years was associated with CSF-lactate above >2.1 mmol/L.