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Chronic migraine and associated autonomic disorders (epidemiological, clinical, neurophysiological and therapeutical study)


Author: Odobescu Stela
Degree:doctor habilitat of medicine
Speciality: 14.00.13 - Neurology
Year:2012
Scientific consultants: Stanislav Groppa
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Victor Lacusta
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council: DH 50-14.00.13
State University of Medicine and Pharmacy "Nicolae Testemitanu"

Status

The thesis was presented on the 25 April, 2012
Approved by NCAA on the 5 July, 2012

Abstract

Adobe PDF document1.63 Mb / in romanian

Keywords

chronic migraine, frequent migraine, autonomic profile, trigeminal somatosensory evoked potentials, comorbid disorders, coping strategies, heart rate variability, transcranial electrical stimulation

Summary

The thesis contains 224 pages of main text, 313 references, 4 attachements, 37 tables and 25 figures. The results obtained have been published in 74 scientific works.

Domain of study: neurology, neurophysiology, psychology.

The aim and objectives of the study: on the basis of the epidemiological, clinical and neurophysiological investigations to study the degree, the level and modalities of the autonomic nervous and trigeminal system involvement in chronic migraine (CM) patients for diagnosis and treatment’s optimisation.

Methodology of the scientific research: epidemiological, clinical, psychological, autonomic, neurophysiologic, and statistical evaluations. Novelty and study originality: For the first time the prevalence of primary headaches and CM has been determined in the Republic of Moldova with the existence of specific features in clinical pattern of CM patients, in vegetative profile and autonomic regulation of cardiovascular system and functional state of trigeminal system; the first placebo controlled treatment of CM patients by transcranial electrical stimulation has also been done.

The scientific issue solved in the thesis consists in determining the epidemiological and clinical features of chronic migraine in relation with autonomic and trigeminal system's dysfunction that allow elaboration of optimal diagnostic, preventive and treatment strategies.

Theoretical value: Some characteristic features of autonomic nervous system implication at several levels of migraine chronification have been specified. It was determined that the high prevalence of CM in the the Republic of Moldova depends on a combination of several medico-social and psychosocial factors (attitude to drugs, high pain tolerance). It has been shown that CM is associated with a stable comorbid constellation (pain, affective and autonomic comorbidity) and also the fact that some types of passive coping strategies favor migraine chronification.

Practical value of this work consists in demonstration of the necessity for diagnosis of segmentary and suprasegmentary autonomic disorders in patients with CM by the use of autonomic profile and analysis of heart rate variability; the refinement of recommendations for changing of coping strategies and treatment by transcranial electrical stimulation.

Implementation of scientific results was done in the process of diagnosis and research of the headache department of the Institute of Neurology and Neurosurgery, the Republican Clinical Hospital of Psychiatry, the Municipal Clinical Hospital for children „V. Ignatenco”, the academic clinic Neuronova-plus.