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Optimal management of airplane headache (AH) is still unresolved. A female, 53 years, complained of severe short-lasting jabbing pain attacks over the forehead and in the eyebrows, mainly on the left side, that occur during take-off and landing. Neurological, opthalmological, and otolaryngological examinations and brain MRI were normal. It was diagnosed as AH. The patient was recommended to take 10 mg rizatriptan 30 min before the flight. It resulted in a complete absence of headache during the take-off and significant decrease of pain intensity during the plane descending. Based on the flight duration (about 2.5 h) and rizatriptan pharmacokinetics, the patient was recommended to take a second dose of rizatriptan 10 mg 1 h before flight ending. The patient reported a complete absence of pain attacks during the next flights. The effectiveness of AH pain attack prevention is based on the pharmacokinetic properties of the drug, time of pain onset during flight, and the flight duration.

The aim: Assess quality of diagnosis and treatment of primary headaches (PH) in Poltava region. Materials and methods: There were examined 195 patients with PH who were previously consulted by different specialists due to headaches. We analyzed previously established diagnoses, previous consultations and prescribed investigations due to headache, drugs that were prescribed for headache treatment. Results: The misdiagnoses of PH were made due to considering the headache as secondary (as sign of dyscirculatory encephalopathy, arterial hypertension, autonomic dysfunction, cervical ostheochondrosis). Patients older 40 years were misdiagnosed more often with dyscirculatory encephalopathy, while patients under 40 years were more frequently misdiagnosed with autonomic dysfunctions. Patients sought medical help for headache problem and were repeatedly examined by different specialists (general practitioner, neurologist, cardiologist, ophthalmologist, oyorhinolaryngologist, neurosurgeon). Doctors prescribed a large number of identical uninformative neuroimaging and neurofunctional methods regardless of PH nosologies. Also it had been often prescribed therapy with the use of vascular, metabolic, nootropic drugs without specific pathogenetic effects for PH. Conclusions: It is necessary to improve the diagnosis and treatment of PH according to international standards by raising awareness among general practitioners, neurologists and other specialists about the basics of PH diagnosis and treatment.

The aim: We studied prevalence, intensity and predictors of fatigue in patient with episodic migraine (EM). Materials and methods: We enrolled in the study 85 patients with EM and 88 healthy subjects. Fatigue was identified according to Fatigue Severity Scale. We recorded socio-demographic factors: gender, age, marital status, formal education level, employment status, smoking. Anxiety and depression symptoms were assessed by Hospital Anxiety and Depression Scale, daytime sleepiness was measured by Epworth scale. The co-morbidities included history of low back pain during last year, arterial hypertension, diabetes mellitus and abdominal obesity. It was analyzed usage of non-steroidal anti-inflammatory drugs, combined analgesics, triptans for abortive migraine treatment. Results: Fatigue prevalence in patients with EM was 41,2%, which was significantly higher than in healthy controls (11,4%). Fatigue intensity in episodic migraineurs was 5,7 (4,9-6,8) and did not differ significantly from fatigue intensity in healthy individuals – 4,9 (4,5-5,8). In multivariate logistic regression analysis independent predictors of fatigue were only migraine-related factors (number of migraine headache days per month, headache severity and migraine prodrome presence). There was weak direct correlation between the number of headache migraine days per month and fatigue intensity. Conclusions: 1. Fatigue prevalence in patients with EM is significantly higher than in healthy controls. 2. In patients with EM fatigue has migraine-related predictors.