Headache has special importance during pregnancy and postpartum period. The health-care professionals and patients report headache management as challenging during pregnancy and lactation period. Cautions are recommended in preganancy and lactation due to maternal and fetal/newborn risks. Most headaches in the first trimester are due primary headaches. Nevertheless, the incidence of secondary headaches increase in the last trimester and post-partum period. Red flags prompt early evaluation in a patient with headache. Assessment of headache patient requires a detailed history of the headache characteristics and performing appropriate examinations. Approach to headache and strategies to promote best practice in preganancy and lactation will be reviewed.

Objectives: Diabetic peripheral neuropathy (DPN) is the most common and troublesome complication of diabetes leading to great morbidity and resulting in a huge economic burden for diabetes care. Over half of people with diabetes develop neuropathy. Also, DPN is a major cause of reduced quality of life due to pain, sensory loss, gait instability, fall-related injury, and foot ulceration and amputation. The aim of this study was evaluating the effects of lifestyle interventions on diabetic neuropathy severity in diabetes type 2 outpatients.
Methods: This clinical trial conducted on 74 patients with DPN that divided with random allocation into intervention or control group. The lifestyle interventions applied in the intervention group beginning four educational sessions on lifestyle that emphasize strategies for lowering blood sugar, increasing physical activity, promoting weight loss, prudent diet, and foot caring. Each session was lasted for1.5 hour. Then patients followed for 12 weeks. During this period, they received counseling on mentioned lifestyle interventions. DPN severity in both groups measured using modified Toronto Clinical Neuropathy Score (mTCNS) at the beginning of study and at the end of counseling for 12 weeks.
Results: Comparing differences of mean of DNP severity before and after lifestyle intervention between two groups of study, there was a significant difference (p<0.001). DNP severity in control group had not any change or it increased in some participants, but DNP decreased in intervention group, after applying lifestyle intervention.
Conclusion: Lifestyle interventions can contribute to reducing DPN severity, and consequently decreasing neuropathic pain.

Objectives: The aim of the study was to investigate the effect of ultrasound guided superficial cervical plexus (SCP) block versus greater auricular nerve (GAN) block for on postoperative tympanomastoid surgery analgesia.
Methods: In this prospective, randomized, single-blind study, a total of 50 patients aged between 25 and 70 years, those who were in the American Society of Anesthesiologists I-II class and underwent tympanomastoid surgery were included in the study. Patients were randomized to either Group Y: intravenous patient-controlled analgesia tramadol (IV PCA) + SCP block; n=25 and Group G: IV PCA + GAN block; n=25. Postoperative pain was evaluated at the 2nd, 6th, 12nd, and 24th hours using the Visual Analogue Scale (VAS) and postoperative 6th, 12nd, and 24th hour follow-up results were evaluated to identify the quantity of tramadol use.
Results: The VAS scores at all measures time were found to be no statistically significant difference between groups (p>0.05). The amounts of PCA tramadol consumption at all measures time were significantly lower in Group Y than in Group G (p<0.05).
Conclusion: The results of this study have indicated that SCP and GAN blocks can be used for pain control after tympanomastoid surgery. We believe that the only disadvantage of SCP block application with lower amounts of tramadol use is that the complications that can occur are more serious than those that can occur in GAN application.

Objectives: Trigeminal neuralgia (TN) has been effectively treated by radiofrequency thermocoagulation (RFT) of the gasserian ganglion. Recently, pulsed radiofrequency (PRF) is becoming an alternative therapy for patients with trigeminal neuralgia. It is unclear whether the combination of RFT with PRF may decrease post-operative complications while maintaining long-term pain relief.
Methods: Twelve patients with idiopathic TN who had undergone combined RFT and PRF of the gasserian ganglion were evaluated. PRF (42 °C, 45V, 20 ms, 120 seconds) was administered, and then RFT (65 °C, 90 seconds) was performed to the gasserian ganglion. The post-operative pain relief and complications were evaluated at 1, 6, 12 and, 24 months after treatment.
Results: 10 patients (83.3%) reported significant pain relief (VAS 3) at 1 month following the treatment, while 8 patients (66.6%) at 6 months, 5 patients (41.6) at 12 months, and 2 patients (16.6%) at 24 months were pain-free. Two of the patients did not have pain relief (VAS ≥3), and 2 patients were still pain-free by the 24th month. The mean time of pain relief was 14 months. One patient had numbness in the tongue for about a year, while in the other patients, no serious complications were reported.
Conclusion: A combination of RFT with PRF could help eliminate postoperative complications of trigeminal neuralgia. We sugesst that combining RFT and PRF therapy may serve to decrease the side effects but not increase the pain relief.

Objectives: We aimed to retrospectively investigate the efficacy of ultrasound guided rectus sheath block (RSB) method in our study.
Methods: We scanned 235 patient files operated for abdominal pathology. Patients meeting the criteria were evaluated for intra-operative rectus sheath block and two different groups were formed. In these two groups of patients visual analogue scale (VAS) values recorded from the postoperative pain follow-up form and analgesic delivery (DEL) and analgesic demand (DEM) values recorded from patient controlled analgesia (PCA) device were compared. In addition, complaints of nausea, vomiting and constipation were evaluated.
Results: Postoperative VAS values (Postoperative 1, 12 and 24 hours p<0.001), DEM values (Postoperative 1, 12 and 24 hours p<0.001) and total amount of morphine consumed (Postoperative 1, 12 and 24 hours p<0.001) were lower in patients with RSB. Also, in patients with RSB nausea (p=0.014) and vomiting was less seen postoperatively (p=0.007). In the first 24 hours after surgery, constipation was seen in 8 patients with RSB and constipation was seen in 30 patients without RSB (p=0.00).
Conclusion: Ultrasound guided rectus sheath block is an effective method for postoperative pain control.

Objectives: Comorbidity of migraine and mood disorders has long been recognized. Most of the studies have focused on the relationship between migraine and major depression with only few studies suggesting a special association between migraine and bipolar spectrum disorders. We aimed to evaluate the prevalence of bipolar disorder in migraine patients in a specialized headache outpatient clinic.
Methods: The sample consisted of 78 consecutive patients with migraine headache presenting to the specialized headache outpatient clinic in a Medical Faculty. Migraine diagnosis was established with the International Headache Society’s criteria for migraine. Patients were evaluated with Structured Clinical Interview for DSM-IV for mood disorders. Bipolar spectrum definition was broadened with the presence of Akiskal’s criteria for affective temperaments (cyclothymic, hyperthymic, irritable, and depressive).
Results: Patients in the bipolar spectrum comprised 10.3% (n=8) of the sample. 11 patients (14.1%) had a diagnosis of unipolar depression and 7 patients (9%) had a diagnosis of dysthymic disorder. 41% of the patients (n=32) had an affective temperament. Bipolar disorder was observed with increased frequency in this migraine sufferer population, supporting previous findings of increased prevalence of bipolar disorders in patients with migraine.
Conclusion: Increased frequency of affective temperaments might be considered in the context of a common pathophysiological background for migraine and bipolar disorders where these temperaments are sub-threshold presentations of mood disorders. Therefore, the definition of patients with comorbid migraine and bipolar disorder may serve as a more homogenic subgroup of mood disorders for further studies.

Tardive dyskinesia and tardive dystonia are caused by dopamine receptor blocking agents, mostly antipsychotics and sometimes antidepressants or calcium channel blockers. Duloxetine is a serotonin-noradrenaline reuptake inhibitor used in the treatment of diabetic neuropathic pain and fibromyalgia, as well as major depression. In this case, we aimed to discuss the tardive dyskinesia-like appearance of a patient using duloxetine due to fibromyalgia.

Photopsia, fortification spectra, and the slow propagation of a scintillating scotoma across the visual field are typical diagnostic features of the visual aura of migraine. In the vast majority of cases, the diagnosis can be made without the need for further investigations. Herein, we report three consecutive cases with an astrocytoma and discuss clinical features of migraine-like visual aura.

Fahr disease is an idiopathic disorder characterized with deposition of calcium and a few other minerals in basal ganglia, cerebellum and subcortical brain area. A 51 years old female with the complaints of pain, numbness, tingling and weakness in both upper extremities for six months was referred to our electromyography laboratory with a suspicion of carpal tunnel syndrome. She got the diagnosis of Fahr disease upon the investigations for the convulsions that she experienced ten years ago. Beside, she had a generalized anxiety disoder. Neurological examination revealed mild to moderate weakness in flexion and extension of forearm, and extension of hand on both sides. She described dysesthesia on C6 & C7 dermatomes, bilaterally. Symmetric calsifications on both cerebellar hemispheres and basala ganglia were present on cranial CT. Median and ulnar nerve conduction studies were normal on both sides. Concentric needle electromyography revealed chronic neurogenic changes on the morphology of motor unit potentials recorded from the muscles of C6 & C7, bilaterally. Cervical magnetic resonance imaging revealed discopathies on C4-5, C5-6 and C6-7 levels causing myelomalacia. Neuropathic pain, paresthesia or muscle weakness on upper extremities are rare in Fahr disease. Presented case got the diagnosis of cervical discopathies in late as those findings were supposed to be related with Fahr disease. Therefore, clinicians should be aware of common findings occured during the course of this disease, and consider the possible coincidental pathologies when the atypical neurological deficits are observed in these patients.