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Introduction: Chronic headaches account for a significant proportion of people leading a poor quality of life. Chronic cluster headaches can be defined as episodes of headache usually around the eye in the pattern of a cluster lasting 15-180 minutes each followed by multiple similar episodes occurring at a frequency of 1-8 times per day.Method: This cross-sectional study was conducted in Jinnah Postgraduate Medical Center, Karachi. One hundred patients who were diagnosed cases of chronic cluster headaches were asked to fill the Beck Hopelessness Scale (BHS), Headache Impact Test (HIT), and Hospital Anxiety and Depression Scale (HADS).Results: Of our study subjects, 57 were males and 43 were females. The mean HIT-6 score among these patients was found to be 60.5±7.67 (p-value = 0.04). The mean BHS score among these patients was found to be 13±6.87. The mean HADS reporting anxiety (HADS-A) was found to be 12.54 ± 5.65; whereas, the mean HADS reporting depression (HADS-D) was found to be 7.65 ± 4.65.Conclusion: Patients with chronic cluster headaches have higher scores than the general population. There is an association between headache syndromes and depression which require further investigation.

Introduction Lower back pain is an extensive problem globally, and quite prevalent in Pakistan as well. In most cases of lower back pain, the cause is lumbar disc herniation. To treat this pain, there are various treatment options available. In this study, we aim to find the efficacy and safety of pregabalin in lower back pain due to lumbar disc herniation. Methods We conducted an open-label prospective trial in a public tertiary care hospital in Karachi, Pakistan, for a duration of five months, i.e. from July 2019 to December 2019. A total of 105 patients were randomized into two groups: pregabalin group and placebo group, and they were required to respond to visual analog scale (VAS) on day 0 and week 12 of the study. Results The results showed a significant reduction in pain over time in both the groups: pregabalin (p-value < 0.0001) and placebo (p-value < 0.0001). However, the difference in pain reduction between pregabalin and placebo was not significant (p-value = 0.57). The most commonly reported side effects were somnolence and dizziness. Conclusion Based on the results of this study, we conclude that adding pregabalin to non-steroidal anti-inflammatory drugs (NSAIDs) and physiotherapy had no significant effect on pain reduction. Further large-scale studies are needed to evaluate the role of gabapentoids in lower back pain due to lumbar disc herniation.

Cerebral toxoplasmosis is a rare condition that predominantly affects immunocompromised people and is relatively uncommon in immunocompetent individuals. Acute toxoplasmosis primarily presents with focal and diffuse neurological signs and symptoms depending on the site of the lesion, the degree of local damage, and the severity of inflammation. In this report, we present a case of cerebral toxoplasmosis in an immunocompetent adult female who presented with an altered level of consciousness, fever, headache, and shortness of breath. This case highlights the diagnostic challenges that may arise when dealing with patients who have a wide range of clinical manifestations.