HEADACHE

HEADACHE RESEARCH & EDUCATION 

Phase II, III and IV clinical trials (Table) as well as self-funded research programs on migraine, tension-type headache and cluster headache are performed at the headache clinic.

Three doctoral theses are currently being prepared in Ward A and the Headache Outpatient Clinic:

1. Doctoral thesis on pharmacoresistance in neurologic disease:

 The nocebo effect on brain diseases 

(by neurologist Ioanna Spanou, MD)

SUMMARY

Introduction: The nocebo effect is a cognitive reaction manifested by adverse effects in a treatment that are associated with the negative predisposition of patients that this treatment will cause more harm than good. This predisposition is inherent in all humans as a precautionary behavior, as is the placebo phenomenon, which is related to the reward system that promotes nutrition and sexuality. For some people, however, these phenomena are magnified. Nocebo reduces patient compliance and greatly reduces the therapeutic effect of a treatment. Purpose: to map CNS activation sites in the nocebo response and to measure the phenomenon in various CNS diseases with clinical questionnaires (Q-No). Method and Patients: Patients with migraine will be included, which will mediate nocebo verbally ("I will give you an intravenous substance that can cause you migraine" while administering saline) and will undergo fMRI immediately. The experiment consists of seven separate halves and will be repeated critically during a random migraine. Nocebo will be measured in patients with fibromyalgia, multiple sclerosis, and primary headaches. Conclusion: these experiments will identify areas in the limbic system (most probably) where the nocebo is estimated to be created and modified. Associating specifically with migraine is an essential goal, because pain is also controlled by similar areas, which are sensitive to cognitive variables.

2. Doctoral thesis on Headache and cerebrovascular disorders #1:

Clinical manifestations of headache and correlation with localization of ischemia using MRI - the potential role of atherosclerosis in secondary headache.

 (by neurologist Giorgos Karagiorgos, MD)

SUMMARY

Introduction: Acute ischemic stroke headache is considered a relatively common symptom, however, the number of studies investigating the relationship of headache to ischemic stroke is relatively limited, and the pathophysiology of pain remains unknown. Objective: The relationship between headache and its characteristics in patients with ischemic stroke, the location and type of ischemic stroke using MRI and the possible role of atherosclerosis. Material and Method: Patients with ischemic stroke who are admitted to the Stroke Unit will be included. Patients will be divided into 2 groups, based on the presence of headache 24 hours before and 48 hours after ischemic stroke. Magnetic resonance imaging will compare the location and size of ischemic infarction in patients with and without headache. In addition, the possible role of atherosclerosis using cervical Doppler will be investigated. Conclusions: Any association of headache with the location and size of ischemic stroke will be reported, and the relationship of atherosclerosis as a potential pathophysiological manifestation of headache will be discussed.

3. Doctoral thesis on Headache and cerebrovascular disorders #2:

Factors determining the onset of stroke headache, its association with etiology and the predictive value of stroke headache in relation to the initial and after 6 months outcome of disease

 (by neurology resident Ariadne Daponte, MD)

SUMMARY

Introduction: Headache is a relatively common symptom in acute ischemic stroke, with a high incidence (8-34%) according to the recent literature. However, the study of the role of headache as a predictor in stroke and many related additional parameters are not sufficiently elucidated, and sources from the literature mainly come from retrospective studies. Purpose: The primary objective of the current prospective study is to investigate the role of headache in the severity of stroke in the acute phase but mainly in its subsequent outcome over a period of 1 year. Secondly, the factors affecting the manifestation of headache will be studied in relation to the etiology of stroke, as well as the potential differentiation of the predictive value of headache depending on the etiology of stoke. Material and Method: The study will include all patients with stroke and imaging on brain MRI who will be admitted to the stroke unit and will be classified into two groups, with or without headache. Subsequently, all clinical features and factors from the individual history will be studied and patients will be classified according to the etiology of stroke. The reassessment will take place in two stages, studying the intra-hospital outcome and then the development and prognosis of stroke a year later, using both clinical criteria, scales of severity and disability as well as imaging. Conclusions: The predictive value of headache for the initial and subsequent outcome of the stroke will be studied 1 year later, while an attempt will be made to establish the profile of the patient with ischemic stroke headache.

UNDERGRADUATE EDUCATION

The clinic provides theoretical & practical training to undergraduate students of the School of Medicine National and Kapodistrian University of Athens, according to the educational program of the 1st Neurology Department. 

POSTGRADUATE EDUCATION (MASTER DENTAL PAIN)

In collaboration with the Dental School of the National and Kapodistrian University of Athens, the Headache Clinic offers postgraduate students training in the Oral and Maxillofacial Pain (6 months internship). It is also planned to create a special postgraduate master's degree program, which will also provide postgraduate students with training. The specialized neurologists at the 1st Neurological Department of the National and Kapodistrian University of Athens, are also part of the training program of the Headache Clinic. External neurologists who provide hands-on training in headache management will also be included in the Practitioner trainees, subject to approval by the Director of the Department (Prof. L. Stefanis).