ÖzetGebelik ve doğum sonrası dönemdeki baş ağrıları özel bir önem taşımaktadır. Bu dönemdeki baş ağrısı yönetimi sağlık çalışanları ve hastalar tarafından zorlayıcı olarak bildirilmektedir. Başağrısına doğru yaklaşım hem anne hem de fetal/yenidoğan risklerinin önlenmesi açısından önemlidir. İlk trimesterdeki baş ağrılarının büyük çoğunluğu primer baş ağrıları grubundadır. Gebeliğin son trimesteri ve doğum sonrası dönemlerde, sekonder baş ağrılarının sıklığı ise artmaktadır. Baş ağrısı hastalarında kırmızı bayrak belirti ve bulgularına dikkat edilmelidir. Baş ağrısı hastasının değerlendirilmesinde detaylı anamnez alınması; doğru ve eksiksiz olarak fizik ve nörolojik muayene yapılması yanında gerekirse ileri tetiklerin yapılması da önemlidir. Bu derlemede gebelik ve laktasyon dönemindeki baş ağrılarına yaklaşım ve en iyi medikal uygulama stratejileri gözden geçirilmektedir. Anahtar sözcükler: Tanı; migren; primer baş ağrıları; kırmızı bayrak bulguları; sekonder baş ağrıları; tedavi. SummaryHeadache 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.

Background/aim: To compare the changes in pain-related symptoms of inguinal hernias from initial admission to postoperative month 6 following 2 herniorrhaphy techniques. Materials and methods:Patients with unilateral inguinal hernias were scheduled for either Lichtenstein or self-gripping polypropylene mesh repair. Patients were preoperatively evaluated with a visual analog scale (VAS) and a Turkish version of the Douleur Neuropathique 4 (DN4) questionnaire and the complaints related to pain were noted. After surgery, patients were discharged without early complications. Patients were reassessed at postoperative month 6. The late-term complaints of pain as well as neurological findings were evaluated using the VAS and the Turkish version of the DN4 questionnaire. Quality of life was also assessed with the Nottingham Health Profile (NHP).Results: Thirty-four patients underwent conventional Lichtenstein repair and 19 patients underwent self-gripping polypropylene mesh repair. Even though decreases in VAS intensity scores for both hernia repair techniques were noted at postoperative month 6 when compared to the preoperative period, no significant changes were found in pain, VAS, total DN4, or NHP scores between groups. Conclusion:Despite its ease of application and short time duration, self-gripping polypropylene mesh repair was not found to be superior to conventional Lichtenstein hernia repair in terms of reducing pain related to inguinal hernia.

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Background: Migraine (MIG) is a common cause of headache and a leading cause of morbidity in Turkey but comprehensive and comparative data evaluating its burden are scarce. The study aimed to describe clinical characteristics and management of MIG and compare MIG with tension type headache (TTH) regarding the burden of disease and healthcare resource utilization. Methods: A total of 1368 patients (aged 18-65 years) with MIG or TTH were surveyed regarding patients’ sociodemographics, headache characteristics, clinical management, burden of disease, quality of life and healthcare resource utilization within the previous 12 months. Data from 1053 patients with definite MIG (dMIG) (n: 924; 87.7%) or definite TTH (dTTH) (n: 129; 12.3%) criteria were analyzed.Results: The frequency and duration of attacks, the number of monthly headache days and of days with analgesic consumption and the severity of headaches were higher in dMIG than in dTTH (p:0.005 for the frequency of attacks and p<0.001 for the others). The benefits from acute medications decreased as the monthly headache days increased in dMIG: 70.9% (1-3 days); 35.9% (4-7 days); 22.1% (8-14 days) and 18.1% (>14 days). Only 222 (36.8%) of definite migraineurs who experienced ≥4 monthly headache days were on preventive treatment. Migraine Disability Assessment (MIDAS) scores were higher in dMIG than in dTTH (24.7±40 vs 10.6±12; p<0.001). The negative impact on the quality of life and the economic loss were also higher with dMIG (p<0.001 for both). More patients with dTTH visited a physician in the previous year (86.8% vs 77.6%; p:0.016) but the number of physician visits were higher in dMIG (3.5 ±5 vs 1.7 ± 1; p < 0.001). The groups were comparable regarding the percentage of patients who had a radiological investigation due to headache but patients with dMIG had more brain magnetic resonance imaging and computed tomography scans (p<0.020 and p<0.003, respectively). Conclusions: It is crucial to timely and correctly diagnosing and optimally managing MIG due to its significant burden. Educational programmes for patients and healthcare providers, adherence and persistence to preventive medications may improve clinical outcomes.

Background. The adverse effects of tumor necrosis factor alpha inhibitors (TNFi) are well characterized but rare adverse events are increasing day by day. Case.We presented an 18-year-old girl with rheumatoid factor positive polyarticular juvenile idiopathic arthritis (JIA) who developed fever, headache, and nausea after the second dose of adalimumab. In addition to her suspicious complaints for meningitis, she had bilateral papilledema and partial abducens nerve palsy. Leptomeningeal contrast enhancement was noted in magnetic resonance imaging (MRI) of the brain. Brain MRI venography was normal. The cerebrospinal fluid (CSF) opening pressure was high but CSF analysis was normal. She was diagnosed with non-infectious subacute meningitis. Since brain biopsy was not performed, no definite distinction could be made between TNFi related aseptic meningitis or cerebral involvement of JIA. Due to the onset of neurological complaints after initiation of adalimumab treatment and rare cerebral involvement in JIA, the drug-associated aseptic meningitis was likely to be responsible in our patient. Adalimumab was discontinued and methylprednisolone followed by methotrexate treatment were initiated. Her symptoms resolved and control brain MRI was normal. Conclusion.Pediatric rheumatologists should be aware of this potentially severe side effect of anti-TNF treatment.