Windows 10 1703 download iso italianos humbled
New roads are being built, public utilities, service accommodations es- tablished. The second shifts the focus from drug addiction to neural sensitization, claiming that triptan overuse triggers adaptations of the trigeminovascular system, thereby facilitating pain transmission and leading to a state of latent sensitization. We are quickly compiling an excellent citation rate although not in all subareas of AI. HTML 1. The streets are neither cen- tralized nor straight; consequently, the town has no core, and in its network of streets, one will find nothing that re- sembles order. In addition to the headache patients commonly suffer from a papilledema that leads to a progressive visual deficit which, if untreated, may results in a complete and irreversible visual loss. The reason of this higher adherence to the diet is still under scrutiny but several reasons are called in cause: an appetite suppression induced by proteins and maybe by ketone bodies KBs , or a modification in hormone secretion insulin, glucagon, ghrelin, adipokines. From a clinical perspective, a comprehensive assessment based on a biopsychosocial approach can provide relevant information to plan a contemporaneous treatment of TMD and headache, together with an intervention targeted to the reduction of psychosocial conditions that can elicit and maintain mechanisms of central sensitization likely responsible of the comorbidity of TMD and headache. The first, stems from the apparent compulsive use of headache medications by MOH patients, and considers this disorder a sort of addiction to symptomatic remedies.❿
Windows 10 1703 download iso italianos humbled.Petronio Álvarez, cada año con mejor balance – Festival de Música del Pacífico Petronio Álvarez
The eventual delivery platform is some combination of specialized SGML viewers and general purpose HTML viewers, and there is a body of page images that goes along with the marked up text just to make things special. From reading the comp. I’m sure there’s other projects underway that have as their goal some substantial italiaons of work completed within this DTD, or perhaps using DTDs based substantially on this one 103 I’d like to see a big more windows 10 1703 download iso italianos humbled that compiled in one place to help the process along.
Please excuse any duplication. Thank you for your attention. Our eleventh annual conference to be held Juneat the University of New Mexico in Albuquerque, a city which balances the prehistoric past with a high-tech present. NASIG’s windows 10 1703 download iso italianos humbled conference provides a forum in which librarians, publishers, vendors, educators, binders, systems developers, and other serials specialists exchange views, present new ideas, proactively seek solutions to common problems, and discuss matters of current interest.
NASIG’s Program Planning Нажмите чтобы увидеть больше invites proposals for plenary papers and preconferences that deal with “big picture” aspects of the theme. We are especially interested in papers or pre- conference ideas that will explore the pioneering boundaries and relationships of NASIG’s various constituencies. The Committee also invites workshop and preconference proposals that will provide practical ideas and assistance in dealing with an information world which combines both print and electronic serial publications.
The Program Planning Committee reserves the right to combine, blend, or refocus proposals to maximize program breadth and relevance to our membership. As a result, only one presenter from proposals submitted by teams may be invited to participate. Any references peeple may be aware of in the area would be appreciated. Busch cs. The aim is to compare the process of converting both journals to various formats, ie.
What does the writer need to be aware of if they are targetting an hukbled journal rather than a paper journal. I am responsible for investigating the document models aspect of this process, ie.
Does anybody know of something else than the above. In particular, I need software, preferably Macintosh-based, to try out different DTD’s in the different markup languages. Does any body have anything or know of anything that I can use downliad where I can get it? The results of this project will be available electronically, and I have already made contact with several subscribers to the list who have described similar activities.
All help appreciated. Basically, CommTech PowerSearch huumbled people handle large amounts of text. After you have tried it, I would be very interested to hear what you think about windows 10 1703 download iso italianos humbled. Feel free to forward this message to any appropriate lists.
Manny Ratafia tmgmail yalevm. Does anyone know about ArborText Document Architect? A list of contents and itallanos instructions follow.
The journal file name of this issue is 3,1-June Previous issues may also be accessed in the same way. Worthington classics. We have found that when journal formats are very similar it is easier to maintain one DTD with a few slight differences in the output specifications than a separate DTD for each journal. We are phasing it out. HTML is inadequate to produce printed journal pages. Harris fharri osa. Help would be appreciated and illucidating! It is the only DTD that comes close to having everything.
It may be overkill for humanities. It is very complex. Great for magazine articles. A bit weak on math but very good all around. HTML 1. It is one of the simplest and most forgiving DTDs around.
Hypermail is coming to the HyperJournal mail archive in the next few weeks, so let’s see what can be done then. It features a long discussion about humblrd future of scholarly journals, in particular the potential for a re-conceptualized system driven by and controlled by scholars. Please excuse any cross-postings. This book captures an Windows 10 1703 download iso italianos humbled discussion about scientific and scholarly journals and their future that took place on a number of electronic forums starting in June and peaking in the fall.
Windows 10 1703 download iso italianos humbled electronic conversations between the principals and bumbled parties continue until now the last message captured in the book is dated March 21, Given the powerful opportunities that electronic networking technologies offer to scholars and scientists, the future of publishing will be debated for years to come. This book is one attempt to capture a key conversation windows 10 1703 download iso italianos humbled the stakeholders in scholarly communications.
Six principal discussants and about two dozen others advance radical and traditional views; they argue for overhaul of journal publication cownload or advocate careful preservation of windows 10 1703 download iso italianos humbled values and roles.
Will electronic technologies save us from the economic pressures of the current papyrocentric publishing system or will they be more expensive than windows 10 1703 download iso italianos humbled dreamed? In his “Overture to the Subversive Proposal,” Stevan Harnad Cognitive Scientist, University of Southampton writes, “For windows 10 1703 download iso italianos humbled, it was only out of reluctant necessity that authors of esoteric publications entered into the Faustian Bargain of allowing a price tag to be erected as a barrier between their work and its intended readership, for that was the only way they could make their work public at all during the age when paper publication was their only option.
The collection, maintenance стенку free ppt templates download slideshare же dissemination of these data will be more costly than printing, but the information will be much more valuable to the scientific community. Of course, when we get to this point we won’t be publishing journals; the output will be called windos else. Scholarly Journals at the Crossroads makes publishing history.
It is the first time that a book derived from a series of wide-ranging Internet windows 10 1703 download iso italianos humbled on a scholarly topic recreates insofar as possible an e-mail experience for a general academic and publishing audience. In their 11703, Ann Okerson ARL and James O’Donnell Professor of Classics, University of Pennsylvaniathe editors of this 9-month long networked conversation write, “This is a book about hope and imagination in one corner of the emerging landscape of cyberspace.
It embraces passionate discussion of an idea for taking to the Internet to revolutionize one piece of the world of windows 10 1703 download iso italianos humbled.
The Association of Research Libraries is a not-for-profit organization representing research libraries in the United States and Canada. Its mission is to shape windoss influence forces affecting the future of research libraries in the process of scholarly communication. ARL programs and services promote equitable access to, and effective use of recorded knowledge in support of teaching, research, scholarship, and community service.
These programs include annual statistical publications, federal relations and information policy, and enhancing access to scholarly information resources through telecommunications, collection development, preservation, and bibliographic control. The Office of Scientific and Academic Publishing works to identify and influence the forces affecting the production, dissemination, and use of scholarly and scientific information.
The book is produced in 7 x 10 format, paperbound, in pages. Its ISBN number is: The humled source files from which the Subversive Book is derived can be found on the Internet as windows 10 1703 download iso italianos humbled ftp to the site ftp.
Proposal To contact the windows 10 1703 download iso italianos humbled Ann Windows 10 1703 download iso italianos humbled ann cni. But of course a lot of restructuring goes with going electronic only, and in the process many paper line-items like subscription and fulfillment, and, to be fair, all overheads from any parallel paleolithic paper operations vanish. Instead of continuing to do these abstract calculations, why not italiaons get the real data from the actual editorial offices of the small but growing fleet of brave new e-only journals?
She also edits the annually updated Directory of Electronic Journals. The email addresses of all the editorial offices are contained therein. Another suggestion: Why not archive the hyperjournal-forum discussion as a Hypermail Archive on the Hypermail Home Page?
All the list owner needs to do is to save all the postings in a unix mail file, with headers. The Hypermail sofware does all the rest. My understanding oso that it is a group of libraries that formed a consortia for the purpose of purchasing electronic journals at a discounted rate.
They may be based at Johns Hokins, but the information I have is sketchy, and my queries via veronica and other internet resources garnered nothing.
I have also check the American Library Directory and Library Literature, but I have been unable to locate any information. If you have any information about this project, I would greatly appreciate your contacting me privately via email. Thank you in advance for any information you can provide. OK, I’ll bite. I would so much like to hear some real numbers that I now am asking about the operating budget of Psycoloquy.
Perhaps then we all can compare that itemization to our own working budgets – downloae of us in the print world. Or is there a large subsidy behind that number? Trust me, if this can be proven through actual working examples, I – and most likely several others – will be converted to this model. It is really the time to pass these ‘abstract calculations’ and hear from those who are producing e-journals about the ‘real’ costs involved.
JHU’s system boasts several interesting features: hypertext bibliographies, a search engine, a convenient and straightforward approach to subscriptions and licensing, and more. You can find out more at JHU’s Web site; look under the icon for the university’s libraries. Glad you asked. No secret hidden subsidies so far! But Psycoloquy is atypical for one specific reason, so not the right journal on which to base extrapolations: It is a journal of Open Peer Commentary.
Most journals dowload not. If an article is accepted, there is a call for multiple commentary. One day it may be possible to compare, but not yet. The comparison now would be flattering to Psycoloquy, but meaningless because of the scale differences. I think the best comparisons will be with conventional journals with comparable subject matter, submission rates, acceptance rates, annual article quotas, and windows 10 1703 download iso italianos humbled.
To be most informative, they should also be equal in number of years of publication, so new journals are compared with основываясь на этих данных journals, where start-up costs can be compared, and low initial volume can be equated. So far, I think some of the new maths and computer science elecectronic journals are in the best position to provide data for comparing with their paper homologues, but there may be others. Comparing Psycoloquy to BBS at this point would really be misleading.
I might add that Psycoloquy’s budget is about to grow a bit, in order to set up a system to hypertextify it.
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Each article in a technical journal such as JAIR is read by a only very small number of people. Even within AI, an expert in one area, such as natural language understanding, will generally ignore articles in another area, such as robotic manipulation. Is the added cost of copy editing and professional formatting worth it for such a small audience? Lest this digress into a flame war, let me point out that I did have a nice email exchange with Michael Boudreau, who wrote the excerpts above in response to my original message.
I don’t disagree with Mike. And I’d be very happy to have a copy editor and a professional designer working on my staff. I think it depends greatly on the nature of the publication. AA ptolemy. Electronic submission does not eliminate all problems, if there is any attempt at “reformatting”. This will often mangle elements such as tables and figures, introducing major errors that can make the paper incomprehensible.
Minor errors can be fixed anytime in on-line publications, this sharply reduces the justification for copy editors. Any reader can drop an email to the author about minor errors. A good argument can be made that unedited papers are actually more accurate, than those “fixed” by copy editors, when we consider the motivational factors mentioned above.
Stodolsky Euromath Center University of Copenhagen david euromath. Wim E. What a complicated bit of nonsense the CNRS is propagating! Si je n’etais pas si surmene, j’ecrirais tout ca en francais, mais sous le poids de mes nombreuses obligations actuelles, je compte sur la bienveillance d’autres pour bien vouloir traduire ce qui suit: I wish I had the time to straighten this out definitively, because otherwise a whole generation of innocent CNRS researchers will be needlessly handicapped by this misguided directive.
Here are the relevant facts and logic: 1 The CNRS directive does not distinguish between electronic journal publication and electronic preprint publication, and I will consider the cases separately, but the answer is the same for both: There is no problem, either in principle or in practice, with electronic dating; and the huge redundancy of the Internet provides many convergent cross-checks on the validity of a date — moreso than dated pieces of paper!
Each article in Psycoloquy is published on a calendar date, which remains part of its citation archive in perpetuo, along with the volume number and item number no more need for issue numbers, for reasons that should be obvious: articles can be published immediately after passing peer review, acceptance, and editing.
No need to wait to collect them in an “issue” — consisting usually of unrelated articles anyway. If my Subversive Proposal vide infra is followed and authors establish public electronic preprint archives at their institutions for all their work, there is no reason a similar protected, coded, permanent dating system cannot be implemented for those archives too. To imagine otherwise is to have a very limited grasp of the reality of electronic information and paper information too, by the way.
Perhaps CNRS recommends that scientists not reveal their results on radio or TV either, because of the impossibility of establishing date information in nonprint media? But there is a growing number of electronic-only journals that are publishing articles whose only form is and will ever be electronic.
So unless the CNRS’s objective is to link the fate of its researchers inextricably, sink or swim, with the current paper flotilla, I advise them to undo this short-sighted directive at once, because the entire literature is poised to take to the skies, sooner or later and this directive only tilts the balance a bit more in favor of later — or at least later for France.
Alas it is in English, but there are some brilliant and eloquent spokesmen for this in French too. Only last night I saw on French TV5 the redifussion of a March programme featuring, among others, Jean-Claude Guedon of the University of Montreal, a passionate and articulate advocate of electronic publication as a new resource for reasserting the strength of francophonie in science and scholarship.
Current Contents , November 11 Garson, L. Ginsparg, P. Computers in Physics. August, American Institute of Physics. The Sciences 18 – Harnad, S. American Psychologist – Science, Technology and Human Values 55 – Review of S. Lock, A difficult balance: Peer review in biomedical publication.
Nature 24 – 5. Psychological Science 1: – reprinted in Current Contents , November 11 Mason ed. Computer Conferencing: The Last Word. Beach Holme Publishers, ; and in: M. Okerson, ed , 2nd edition. Times Higher Education Supplement, Multimedia, p. Washington, DC. Hayes, P. Minds and Machines 2: Library Journal 48 – Odlyzko, A.
This is a subversive proposal that could radically hasten that day. It is applicable only to ESOTERIC non-trade, no-market scientific and scholarly publication but that is the lion’s share of the academic corpus anyway , namely, that body of work for which the author does not and never has expected to SELL his words. He wants only to PUBLISH them, that is, to reach the eyes and minds of his peers, his fellow esoteric scientists and scholars the world over, so that they can build on one another’s contributions in that cumulative.
For centuries, it was only out of reluctant necessity that authors of esoteric publications entered into the Faustian bargain of allowing a price-tag to be erected as a barrier between their work and its tiny intended readership, for that was the only way they could make their work public at all during the age when paper publication and its substantial real expenses was their only option.
This is already beginning to happen in the physics community, thanks to Paul Ginsparg’s HEP preprint network, with 25, users worldwide and 45, “hits” per day, and Paul Southworth’s CICnet is ready to help follow suit in other disciplines.
The only two factors standing in the way of this outcome at this moment are 1 quality control i. The subversion will be complete, because the esoteric — no-market peer-reviewed literature will have taken to the airwaves, where it always belonged, and those airwaves will be free to the benefit of us all because their true minimal expenses will be covered the optimal way for the unimpeded flow of esoteric knowledge to all: In advance.
How do these projects relate to your needs? The goal was to provide a structure participants could use in evaluating and reviewing reports of the various digital library projects and to consider how those project were relevant to their own needs.
Over 30 participants divided into three groups to discuss this topic and compile a list of questions. Each group reported back to the larger group. Here are the reports from each group.
Group 1 What is the library’s role in providing digitized resources? Should it provide access only or should it be seen as a publisher of information. If the latter, how should this activity be financed-via cost recovery or pay per view or some other option.
What is the impact of different cost models on user behavior. What is the importance of the digital library? Are any of these more important than the others? Group 2 -Who is the audience to which the digital library is directed? What are their needs? What is the digital library supposed to accomplish? Which standards still need to be developed?
Are their censorship implications related to such selection? What are the user interface issues? How important is uniformity of interfaces? How can that be done? Group 3 What are the standards and models for access and retention? What is the role of the public services staff in providing mediated access to and searching of electronic resources?
How will this role change as the digital library develops? What responsibilities should libraries assume for archiving of digital resources? What standards are their for bibliographic control of digital resources? Byron’s Poetical Works. The Scene wherein Thyestes eats his own Children, is to be performed by the famous Mr Psalmanazar 1 , lately arrived from Formosa ; The whole Supper being set to Kettle-drums. Accommodations are provided, and Persons admitted in their masquing Habits.
Any Person may agree by the Great, and be kept in Repair by the Year. The Doctor draws Teeth without pulling off your Mask. James’s Coffee-house, either by miscalling the Servants, or requiring such things from them as are not properly within their respective Provinces; this is to give Notice, that Kidney, Keeper of the Book-Debts of the outlying Customers, and Observer of those who go off without paying, having resigned that Employment, is succeeded by John Sowton; to whose Place of Enterer of Messages and first Coffee-Grinder, William Bird is promoted; and Samuel Burdock comes as Shooe-Cleaner in the Room of the said Bird.
They are not only instructed to pronounce Words distinctly, and in a proper Tone and Accent, but to speak the Language with great Purity and Volubility of Tongue, together with all the fashionable Phrases and Compliments now in use either at Tea-Tables or visiting Days.
Those that have good Voices may be taught to sing the newest Opera-Airs, and, if requir’d, to speak either Italian or French, paying something extraordinary above the common Rates. They whose Friends are not able to pay the full Prices may be taken as Half-boarders.
Team 1 — Thanks for a great presentation. Although I did not sign up for the various social media accounts for personal and professional reasons, your presentation allowed me to learn more about three social media platforms.
Your last paragraph is really insightful and it ties to a previous discussion we had in the Entrepreneur Bootcamp. Social media was mainly developed as a connection tool, not as a tool for PD. Zaznacz wszystko. Analityczne dostawcy oprogramowania. Dodano: w kategorii: – autor: admin. Komentarze do wpisu Annasysgoolf 2 czerwca Annasysgoolf 7 czerwca Annasysgoolf 9 czerwca Carlosgub 19 czerwca Carlosgub 20 czerwca Carlosgub 21 czerwca Carlosgub 22 czerwca Carlosgub 23 czerwca Carlosgub 25 czerwca Carlosgub 26 czerwca Shubertrtenemi 26 czerwca Carlosgub 27 czerwca Carlosgub 28 czerwca EdwardGepsy 23 lipca Robertplume 23 lipca Robertplume 24 lipca EdwardGepsy 24 lipca EdwardGepsy 25 lipca Robertplume 25 lipca Robertplume 26 lipca Robertplume 27 lipca Robertplume 28 lipca Robertplume 29 lipca Robertplume 30 lipca Further discussion and evaluation of the elements and the outcome predictors are important for future planning.
Migraine is a common debilitating brain disorder characterized by severe headache attacks with various associated neurological symptoms. About one-third of migraine patients experience an aura preceding the headache phase: hence migraine with and without aura. Many migraine patients also suffer from comorbid neurological disorders, such as epilepsy, depression and stroke.
Migraine is a genetic disease with both environmental and genetic factors determining the susceptibility to attacks. Recent technological advances in genetic analysis, which allowed simultaneous testing of hundreds of thousands of single nucleotide polymorphisms SNPs in tens of thousands of migraine patients in genome-wide association studies GWAS , made it feasible to identify robust gene variants for the common forms of migraine. Whereas GWAS performed in various migraine subtypes yielded different top hits for the different subtypes, additional analyses seem to point to a shared genetic underpinning in migraine.
Identified gene variants point towards various molecular pathways, e. GWAS data sets, to some extent, can also been used to identify the type of brain cell involved in pathology. GWAS also enable the identification of shared genetic factors for diseases comorbid with migraine.
Unlike gene mutations in monogenic migraine subtypes, the effect size of gene variants in common migraine is small, thus complicating direct translation to diagnostic tests, pathogenetic mechanisms, and treatment targets. In fact, strategies to properly address the biological role of these variants are still being developed. The coming years will show the true impact of these combined genetic approaches on the identification of genes, pathological mechanisms, and diagnosis of patients in migraine.
Research has devised various techniques for investigating nociceptive and non-nociceptive somatosensory pathways in patients with neuropathic pain. The most widely agreed tools in use today include neurophysiological techniques and skin biopsy. Laser Evoked Potentials LEPs are the easiest and most reliable neurophysiological technique for assessing nociceptive pathway function.
In diseases associated with nociceptive-pathway damage, LEPs can be absent, reduced in amplitude or delayed in latency.
Skin biopsy is a reliable and minimally invasive tool for investigation of nociceptive fibres in human epidermis and dermis. Researchers have used this technique for assessing epidermal nerve fibres qualitatively and quantitatively. Skin biopsy can be done at any site of the body, with a disposable punch, using a sterile technique, and under local anaesthesia.
Many investigators have used skin biopsy to investigate epidermal nerve fibres in various peripheral nerve diseases, such as diabetic neuropathy, infectious and inflammatory neuropathies and neuropathies associated with systemic diseases. In all studies, epidermal nerve fibre density was significantly lower in patients with neuropathy than in controls.
Patients suffering from chronic headaches challange health care systems. A proportion of chronic headache patients does not properly respond to prophylactic treatments or shows low tolerability profile and remains in need for alternative therapeutic strategies and options.
The improved understanding of head pain pathophysiology has focused attention on the role of neural structures both at peripheral and central nervous system level. Thus in the attempt to improve chronic intractable neurovascular headache migraine and cluster headache patients a number of neuromodulation procedures targeting peripheral and central nervous system structures have been tried.
So far, efficacy and safety of various non-invasive and invasive stimulation procedures and devices have been investigated. Vagus nerve stimulation, supraorbital stimulation and single-pulse transcranial magnetic stimulation are considered non invasive neurostimulation options. While invasive procedures are occipital nerve stimulation, sphenopalatine ganglion stimulation and hypothalamic deep brain stimulation.
Years after their introduction there is still debate about their use and place in clinical practice. Results from open label series and few controlled trials suggest the need of further investigations. Criteria employed to define intractable headaches were given more than ten years ago 1. An ad hoc European Headache Federation expert board has reviewed these aspects 2. A still unsolved issue is the lack of adequate placebo to properly design randomized controlled trials in neurostimulation studies.
In patients with chronic pain conditions interpretation of placebo effect is a challange particularly for headache specialists. In chronic migraine and chronic cluster headache patients occurrence of psychiatric comorbidities is frequently encountered. Also, occurrence of medication overuse headache — seen as an addiction behavior – is frequently observed both in chronic migraine and chronic cluster headache.
These factors are often a barrier when selecting patients for neurostimulation procedures. Long term experience with deep brain stimulation of the posterior hypothalamic area in chronic cluster headache has suggested that the generator of the attacks is not there 3. Similarly other neurostimulation procedures tried in migraine and cluster headache have shown poor, unsatisfactory ability to stop ongoing attacks. Towards a definition of intractable headache for use in clinical practice and trials.
Cephalalgia ; — Neuromodulation of chronic headaches: position statement from the European Headache Federation. J Headache Pain. Success, failure and putative mechanisms in hypothalamic stimulation for drug resistant chronic cluster headache. Pain ; 1 : An underlying concept in the new ICHD-3 classification of trigeminal neuralgia is the postulation that clinical presentations matter because they reflect distinct pathophysiological mechanisms.
Previous attempts to establish the connection between the two have yielded uncertain results as the authors have paid limited attention to individual clinical symptoms and signs. Yet, the relatively strict criteria for trigeminal neuralgia and its subgroups yield homogenous populations that allow advantage to be taken of the advances in neurophysiological and imaging methods.
It is now possible to conduct subgroup-specific pathophysiological studies aimed at biomarkers that pave the way for precision diagnosis of TN and individualised therapy. An example of how this might be done comes from recent studies based on sensory profiling of peripheral neuropathic pain.
In a large group of patients with three different diagnoses, cluster analysis of detailed sensory testing revealed three main sensory phenotypes , with the potential to allocate individual patients to these sensory groups . In my presentation I will suggest a pathway as to how to accomplish this. I will start by arguing that the existing data are sufficient to recommend preferred treatment in selected cases.
I will then highlight a number of clinically relevant research questions that can be answered by large-population multi-centre studies applying established methods ranging from QST and evoked potentials to structural and functional neuroimaging of the trigeminal system and linking them with clinical signs and symptoms.
Alongside this, I will discuss the challenges of phenotype profiling that could guide pharmacotherapy with, e. Peripheral neuropathic pain: a mechanism-related organizing principle based on sensory profiles. Pain ; Stratifying patients with peripheral neuropathic pain based on sensory profiles: algorithm and sample size recommendations.
Mild head injury is associated with good recovery in most patients, but with a small risk of poor outcomes. Headache is the most common complication that occurs as an isolated symptom or can be a part of the post-concussion syndrome which can also include dizziness, fatigue, reduced ability to concentrate, psychomotor slowing, mild memory problems, insomnia, anxiety, personality changes and irritability Following head injuries, children may develop headache for the first time or have their previously experienced headache getting worse in severity or frequency.
Post head injury headache is referred to as acute posttraumatic headache if it evolves within one week of the injury and resolves within 3 months and it is called chronic posttraumatic headache CPTH if it persisted for over 3 months. The pathophysiology of posttraumatic headache is not well understood, but likely to involve several mechanisms and factors. It is suggested that even minor head injury may cause a widespread stretching or shearing injuries to the axonal network.
Psychosocial factors may also play a role in the pathogenesis of CPTH. The clinical features of CPTH are similar to primary headache disorders phenotypes with the majority of children presenting with migraine-like headache and probable tension-type headache.
Some children may have mixed or unclassified headache disorders. In the majority of children no investigations are necessary. However, neuroimaging and other investigations may be necessary in children with red flags or abnormal findings on neurological examination. The management of children with CPTH should include reassurances, adequate pain relief and preventative treatment as appropriate.
Multidisciplinary approach is necessary and should include support from clinical psychology and education to help the child achieve normal school attendance and education. The interaction between enzyme inductive antiepileptics EiAED like carbamazepine, phenytoin, primidone, phenobarbitone, rufinamide, lamotrigine, topiramate and COCs is well-known.
Therefore, while taking this medication, the risk of contraceptive failure is quite high. The mechanism of action of enzyme-inductors is to modify the metabolism of the sexual steroids in the liver. Moreover, ethinylestradiol EE might modify the metabolism of certain antiepileptic drugs glucuronization of lamotrigine.
Therefore, the gynaecologist has to be careful when prescribing the pill or administering other types of hormonal contraceptives for WWE. Knowing the interaction between antiepileptics and contraceptives is important to find the most effective medication with fewer side effects.
Nowadays, women with epilepsy do not always get the right information; thus, it is necessary to improve the cooperation and consultation between the epileptologist and the gynaecologist. The information is also needed even if the patient is sexually inactive. Migraine is a complex neuronal disorder where the cortex has a key importance and characteristic headache attack is associated with multiple sensorial disturbances. A cerebral cortical phenomenon known as cortical spreading depression CSD was linked to lateralized headache.
CSD is an intrinsic brain phenomenon to a noxious stimulus such as high potassium or trauma, and manifests as an extreme excitability state of the gray matter with massive depolarization of neuronal and glial membranes and redistribution of ions. Propagating depolarization in the brain parenchyma leads to a release of various vasoactive and nociceptive ions and molecules. Vascular compartment reacts with initial hyperemia followed by long-term oligemia.
It occurs in many species from rodents to primates, though it is hard to initiate and sustain its propagation in gyrencephalic brains. Spreading depression wave involves neuronal, glial and vascular cells, and leads remarkable effects on those compartments and overlying meningeal membranes with capability of triggering peripheral trigeminal fibers and second order trigeminal neurons in the brainstem nucleus, though its effect on subcortical structures are less known.
CSD is implicated in the development of inflammatory response and releasing CGRP and nitric oxide from trigeminal nerve endings. Animal studies investigating the mechanisms of migraine and CSD are usually conducted under anesthesia, despite the fact that pain is a conscious experience.
Anesthesia have profound effects on the mechanisms by which CSD is initiated and propagated, and clearly prevents observation of any associated behavioral response. Therefore CSD studies in awake animals are crucial for translational migraine research.
Cerebral cortex and thalamus are inseparable in sensory processing and thalamic reticular nucleus TRN is the gatekeeper of sensory outflow to the cortex. Electrocorticographic recordings demonstrated the direct propagation of CSD waves in to thalamic reticular nucleus. It was dependent on full conscious experience and highly vulnerable to anesthetics. MK did not exert any effect on CSD induced amygdala activation and anxiety behavior. TRN is also involved in discrimination of sensory stimulus and transient disruption of sensorial perception during migraine headache attacks was reported Boran et al, Involvement of a strategic subcortical thalamic structure by a cortical event is important to explain several clinical features of migraine such as 1 Dysfunction of the GABAergic neurons in TRN would result in enhanced transmission of sensory information to the cortex and disruption of sensory discrimination 2 Photophobia and visual hallucinations of aura may reflect dysregulation of visual stimuli by the TRN, 3 TRN could play a role in either termination or initiation of an attack as sleep is closely related with migraine, attacks are often associated with the circadian cycle and are typically relieved by sleep, 4 Thalamo-cortical gating could be a novel target in migraine as valproate, triptans and CGRP antagonists MK suppressed CSD induced TRN activation.
Common misdiagnoses for TN include dental pathology, other regional neuralgias, short-lasting neuralgiform headaches with autonomic signs SUNHA , cluster headache and theoretically an atypical shorter cluster-tic syndrome CTS. More rarely there may be more sinister underlying disorders tumors, multiple sclerosis that induce TN-like syndromes.
We will outline and highlight the salient features across disorders that will ensure correct diagnosis. Trigeminal neuralgia TN is a neurological disease which is peculiar under several respects.
The diagnosis of TN, in its typical presentation, in unmistakable on clinical grounds alone. Pain manifests with intense bursts that occur and end abruptly and usually last few seconds only. This type of pain is paradigmatic of what pain scholars call paroxysmal pain. The most common verbal descriptors are electric-shock like or stabbing.
Unique to TN is the trigger mechanism. The attacks are evoked by innocuous stimuli in tiny zones of the extra- or intraoral trigeminal territories. The most frequent trigger maneuvers include activities of the daily life such as washing, cleaning, brushing the teeth or talking. Although the trigger zones shared by most patients are confined between the nostril and the lateral perioral region, any area innervated by the trigeminal nerve may do. One aspect of pathophysiology is supported by established neurophysiologic, neuroimaging, and histologic evidence: the primary mechanism is focal demyelination of primary afferents near the entry extra- or intra-axial of the trigeminal root into the pons.
A second pathophysiologic theory, admittedly more debatable, is that hyperexcitable primary afferents, in the area of focal demyelination, become a source of ectopic generation of impulses and ephaptic transmission cross talk from close, healthy nerve fibers.
More supported by evidence from animal models is the generation of high-frequency discharges. A third potential step, with so far almost no sound evidence at all, is that the hyperactivity of primary afferents secondarily induces central sensitization of wide dynamic range neurons in the spinal trigeminal nucleus or even more central changes. Finally, TN is unique also for its pharmacological and surgical treatment.
TN is highly sensitive to voltage-gated, frequency-dependent sodium-channels blockers and almost nothing else , and is the neuropathic pain condition that respond best to surgical lesions of the postganglionic primary sensory afferents. The speaker will present an overview of the methodological potentials and challenges of the HUNT survey.
Results will be displayed regarding prevalences of the common headache disorders and their trends over time. Most importantly, the HUNT-survey enables risk factor analyses. Findings will be reviewed for factors of life such as physical activity, substance use, head traumas, insomnia, and mortality.
Finally, associations between intracranial abnormalities and headache disorders are now beginning to be published from a neuroimaging sub-study HUNT MRI. SD is widely accepted as the pathophysiological event underlying migraine aura, and may play a role in headache pathogenesis in secondary headache disorders such as ischemic stroke, subarachnoid or intracerebral hemorrhage, traumatic brain injury, and epilepsy. Here, we provide an overview of the pathogenic mechanisms and propose plausible hypotheses on the involvement of SD in primary and secondary headache disorders.
SD can activate downstream trigeminovascular nociceptive pathways to explain the cephalgia in migraine, and possibly in secondary headache disorders as well. In healthy, well-nourished tissue such as migraine , the intense transmembrane ionic shifts, the cell swelling, and the metabolic and hemodynamic responses associated with SD do not cause tissue injury; however, when SD occurs in metabolically compromised tissue e.
Recent non-invasive technologies to detect SDs in human brain injury may aid in the investigation of SD in headache disorders in which invasive recordings are not possible.
SD explains migraine aura and progression of neurological deficits associated with other neurological disorders. Studying the nature of SD in headache disorders might provide pathophysiological insights for disease and lead to targeted therapies in the era of precision medicine. The proportion of adult patients reporting non-traumatic headache as their major complaint at ER access ranges from 0.
The main objective is to identify the patients who require urgent investigations besause of a suspected serious secondary cause. The crucial step in the diagnosis is the initial interview. Most patients presenting with headache as the chief complaint have a primary headache disorder, such as migraine or tension-type headache, the diagnosis of which relies on strict diagnostic criteria in the absence of any objective marker.
Secondary headache disorders manifest as new-onset headaches that arise in close temporal association with the underlying cause. Secondary headache should be suspected in any patient without a history of primary headache who reports a new onset headache and in any patient with a new unusual headache that is clearly distinct from their usual primary headache attacks. Since many serious disorders, such as subarachnoid haemorrhage, can present with isolated headache and a normal clinical examination, diagnosis is reliant on clinical investigation.
Subarachnoid hemorrhage should be suspected in anyone with a sudden or a thunderclap headache. Diagnosis is based on plain brain computed tomography and, if tomogram is normal, on lumbar puncture. Reversible cerebral vasoconstriction syndrome should be suspected in anyone with recurrent thunderclap headaches over a few days. Cervical artery dissection, cerebral venous thrombosis, reversible cerebral vasoconstriction syndrome and pituitary apoplexy may present with isolated headache and normal physical examination, normal cerebral computed tomography and normal cerebrospinal fluid.
When computed tomography and lumbar puncture are normal, other investigations are needed, including cervical and cerebral vascular imaging and brain magnetic resonance imaging. Treatment of headaches in the ER should be based on the etiology. The treatment of secondary headaches requires the treatment of the underlying cause and a symptomatic treatment based on intravenous acetaminophen or on opiates depending on the pain intensity. In women migraine prevalence peaks during reproductive years.
Menstruation is a significant risk factor for migraine with attacks most likely to occur between 2 days before the onset of menstruation and the first three days of bleeding. The pathophysiology of menstrual attacks involves estrogen withdrawal and potentially abnormal release of prostaglandins triggered by the end-cycle drop in estrogen level.
Reproductive year are the life span during which many women require effective contraception. Migraine with aura MA and to a lesser extent migraine without aura MO increase the risk for cardiovascular events, especially for stroke. There is a substantial elevation of these risks in migraineurs using combined contraceptive pills COC. Several clinical trials report improvements in migraine frequency and intensity in users of the progestin-only pill POP with desogestrel 75microgram. Both, inhibition of ovulation and ist continous use contribute to reduce hormone flucutations during ist use.
The positive impact of this pill has been shown in MA and MO patients. In women with chronic migraine, the reduction in pain medications used contributes to prevent medication overuse headaches. The existing nosology of cranial-nerve pains does not fully portray the subtle differences between various conditions. However, rather than abandoning many long-established diagnostic terms, this classification retains them, providing detailed definitions for differential diagnoses and their types, subtypes and subforms.
There are several axes of classification: a syndomology neuralgia vs. The authors of the classification tried to incorporate the existing literature into the IHS classification system. The current version defines the trigeminal neuralgia and trigeminal neuropathy. Trigeminal neuralgia is subdivided into classical due to nerve-vascular compression, not purely a nerve vascular contact , idiopathic unknown cause or nerve vascular contact, because the value of a nerve vascualr contact is unclear and secondary due to other disease.
Base don the clinical presentation it is further characterised as TN with and without concomitant facial pain indicating pure response to treatment. The cut-line for distinguishing between an acute and persistent headache is defined to be 3 months: resolution of headache within this period complies with an acute, persistence for the longer time — with a persistent headache.
Headache attributed to the injury to the head is further subclassified based on the severity of preceding trauma. Probably one of the most debated diagnostic criterions of this chapter is the time of onset of headache after a traumatic event. For the main classification it is agreed that causative relation between trauma and development of headache should be within 7 days after the trauma. However based on a data derived from reports of everyday clinical practice alternative criteria published under the Appendix allow the delayed onset of headache, reaching up to 30 days following the injury.
Clinical phenotypes of post-traumatic headache are varying from mild tension-type-like to severe migrainous. Pathophysiological mechanisms of post-traumatic headaches remain largely unclear as a reason to the epidemiological data suggesting, that mild injury to the head represents a greater risk of developing persistent headache. The latter one causes a considerable reduction of health related quality of life and frequently is challenging in terms of treatment, requiring pharmacological preventative medications and non-pharmacological cognitive behavioural treatment, physical therapy, counselling etc approaches.
For treatment resistant cases interventional procedures, usage of onabotulinum toxin A and neurostimulation have been reported to be potentially effective. To determine persistence of and transitions between episodic migraine EM and chronic migraine CM and to describe and model the natural variability of self-reported frequency of headache days. Relatively little is known about the stability of headache days per month in persons with EM or CM over time. Within person variability in headache day frequency has implications for the diagnosis of CM, assessing treatment in clinical practice and for the design and interpretation of clinical trials.
We modelled longitudinal transitions between EM and CM and, separately, headache day frequency per month using negative binomial repeated measures regression models NBRMR. Among the 5, respondents with EM at baseline providing 4 or 5 waves of data, 5, Among respondents with CM at baseline providing 4 or 5 waves of data, had CM in every wave Individual plots revealed striking within-person variations in headache days per month.
Follow-up at 3 month intervals reveals a high level of short-term variability in headache days per month. Nearly three forths of persons with CM at baseline drop below this diagnostic boundary at least once over the course of a year. These findings my influence case definitions of migraine subtypes, the design and interpretation of epidemiologic studies and clinical trials as well as the interpretation of change in headache days in clinical practice.
Impairment of brain solute clearance through the recently described glymphatic system has been linked with traumatic brain injury, sleep deprivation, and aging.
This lecture will summarize new data showing that cortical spreading depression CSD , the neural correlate of migraine aura, closes the paravascular space and impairs glymphatic flow. This closure holds the potential to define a novel mechanism for regulation of glymphatic flow. It also implicates the glymphatic system in altered cortical and endothelial functioning of the migraine brain, which can explain the increased risk of stroke among migraine aura patients.
Many patients report that their need to avoid light is driven mainly by how unpleasant it makes them feel. This lecture will attempt to explain why is light unpleasant. The data presented will show that during migraine, light can trigger the perception of a hypothalamic-mediated autonomic responses such as chest tightness, throat tightness, shortness of breath, fast breathing, faster than usual heart rate, light-headedness, dizziness, nausea, vomiting, dry mouth, salivation, rhinorrhea, stuffy sinuses and lacrimation; b hypothalamic mediated non-autonomic responses such as thirst, hunger drowsiness, tiredness, sleepiness, fatigue, and yawning; c negative emotions such as intense, irritable, angry, nervous, hopeless, needy, agitated, sad, scared, cranky, upset, depressed, disappointed, jittery, worried, stressed, anxious, panic and fear; and d positive emotions such as happy, relaxing, soothing, and calming.
By defining better the aversive nature of light, the findings suggest that the retina and hypothalamus play a critical role in migraine-type photophobia and that photophobia may not depend on hyperexcitable visual cortex, as traditionally thought. We have recently described a macroscopic pathway in the central nervous system — the glymphatic system that facilitates the clearance of interstitial waste products from neuronal metabolism.
Glymphatic clearance of macromolecules is driven by cerebrospinal fluid CSF that flows in along para-arterial spaces and through the brain parenchyma via support from astroglial aquaporin-4 water channels. The glymphatic circulation constitutes a complete anatomical pathway; para-arterial CSF exchanges with the interstitial fluid, solutes collect along para-venous spaces, then drain into the vessels of the lymphatic system for ultimate excretion from the kidney or degradation in the liver.
As such, this may after circulation represent a novel and unexplored target for prevention and treatment of neurodegenerative diseases.